ONTARIO WOMEN’S HEALTH EQUITY REPORT Volume 2 · PDF file2010 Editor: Arlene S. Bierman,...

2010 Editor: Ar lene S. B ierman, m d, m s, f r c p c

O N TA R I O W O M E N ’ S H E A LT H E Q U I T Y R E P O R T

Volume 2

ONTARIO WOMEN’S HEALTH EQUITY REPORT

Project for an Ontario Women’s Health Evidence-Based Report (POWER) Study

Volume 2 Ontario Women’s Health Equity Report, 2010 Improving Health and Promoting Equity in Ontario

ACKNOWLEDGMENTS

The POWER Study is funded by Echo: Improving Women's Health in Ontario, an agency of the Ministry of Health and Long-Term Care. This report does not necessarily reflect the views of Echo or the Ministry.

The POWER Study is a partnership between the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES) in Toronto.

PubLiCATiON iNfOrMATiON

© 2010 St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences

(for the Reproductive and Gynaecological Health chapter) © 2011 Arlene S. Bierman, MD, MS and the Institute for Clinical Evaluative Sciences

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the proper written permission of the publisher.

CANADiAN CATALOGuiNG iN PubLiCATiON DATA

Project for an Ontario Women’s Health Evidence-Based Report: Volume 2 Includes bibliographical references

ISBN: 978-0-9733871-1-7

HOW TO CiTE THiS PubLiCATiON

The production of Project for an Ontario Women’s Health Evidence-Based Report: Volume 2 was a collaborative venture. Accordingly, to give credit to individual authors, please cite individual chapters and titles, in addition to the editors and book title.

for this volume: Bierman AS, editor. Project for an Ontario Women’s Health Evidence-Based Report: Volume 2: Toronto.

Per chapter (for example): Hawker GA, Badley EM, Jaglal S, Dunn S, Croxford R, Ko B, Degani N, Bierman AS. Musculoskeletal Conditions. In: Bierman AS, editor. Project for an Ontario Women’s Health Evidence-Based Report: Volume 2: Toronto; 2010.

The POWER Study Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital 30 Bond St. (209 Victoria St., Room 219) Toronto, ON, M5B 1W8 Tel: (416) 864-6060, Ext 3041 Fax: (416) 864-5641 [email protected] www.powerstudy.ca

www.powerstudy.ca

i

Improving Health and Promoting Health Equity in Ontario

CHAPTER 8Musculoskeletal Conditions

Gillian A. Hawker, MD, MSc

Elizabeth M. Badley, MSc, DPhil

Susan Jaglal, BSc, MSc, PhD

Sheila Dunn, MD, MSc, CCFP(EM), FCFP

Ruth Croxford, MSc

Beatrix Ko, BSc

Naushaba Degani, PhD

Arlene S. Bierman, MD, MS, FRCPC

CHAPTER 9Diabetes

Gillian L. Booth, MD, MSc, FRCPC

Lorraine L. Lipscombe, MD, MSc, FRCPC

Onil Bhattacharyya, MD, PhD, CFPC

Denice S. Feig, MD, MSc

Baiju R. Shah, MD, PhD, FRCPC

Ashley Johns, MSc


Beatrix Ko, BSc


TAbLE Of CONTENTS

Authors’ Affiliations .................................................................................. ii

Acknowledgements ..................................................................................vi

A Guide to Reading Maps ......................................................................xiv

CHAPTER 10Reproductive and Gynaecological Health


Michelle R. Wise, MD, MSc, FRCSC

Lina M. Johnson, RN, MBA

Geoffrey Anderson, MD, PhD

Lorraine E. Ferris, PhD, LLM

Naira Yeritsyan, MD, MPH

Ruth Croxford, MSc

Longdi Fu, MSc



CHAPTER 11HIV Infection

Ahmed M. Bayoumi, MD, MSc, FRCPC


Robert S. Remis, MD, MPH, FRCPC

Sharon L. Walmsley, MD, MSc, FRCPC

Peggy Millson, MD, MHSc, FRCPC

Mona Loutfy, MD, FRCPC, MPH

Tamara Daly, MA, PhD

LaRon E. Nelson, PhD

Sandra Gardner, PhD

Laurel Challacombe, MHSc

Sharmistha Mishra, MD, MSc, FRCPC, DTMH


ii

ONTAriO WOMEN’S HEALTH EQuiTY rEPOrT


CHAPTER 12Social Determinants of Health and Populations at Risk


Ashley Johns, MSc

Social Determinants of Health

Brian Hyndman, MHSc

Christiane Mitchell, MAP

Low-Income Populations


Avram R. Shack, MA

Immigrant and Minority Populations

Maria Isabella Creatore, MSc

Aisha K. Lofters, MD, CCFP

Marcelo L. Urquia, PhD

Farah Ahmad, MBBS, MPH, PhD

Nazilla Khanlou, RN, PhD

Vanessa Parlette, MA

CHAPTER 13Achieving Health Equity in Ontario: Opportunities for Intervention and Improvement


Avram R. Shack, MA

Ashley Johns, MSc

For the POWER Study

TAbLE Of CONTENTSContinued

iii


CHAPTER 8—MUSCULOSkELETAL CONdITIONS Gillian A. Hawker, MD, MSc

Physician-in-Chief and F.M. Hill Chair in Academic

Women’s Medicine, Women’s College Hospital

Professor, Medicine, Rheumatology, and Health Policy,

Management and Evaluation, University of Toronto

Arthritis Society Senior Distinguished Rheumatologist

Investigator

Senior Scientist, Women’s College Research Institute

Elizabeth M. Badley, MSc, DPhil

Head and Senior Scientist, Division of Health Care and

Outcomes Research, Toronto Western Research Institute

Director, Arthritis Community Research and Evaluation

Unit (ACREU)

Professor, Dalla Lana School of Public Health,

University of Toronto

Susan Jaglal, BSc, MSc, PhD

Senior Scientist, Osteoporosis Research Program,

Women’s College Research Institute

Toronto Rehabilitation Institute Chair in Rehabilitation

Research

Vice Chair Research and Professor, Department of

Physical Therapy, University of Toronto

Senior Scientist, Institute for Clinical Evaluative Sciences


Research Director and Practitioner, Family Practice

Health Centre, Women’s College Hospital

Associate Professor, Department of Family and

Community Medicine, University of Toronto

Ruth Croxford, MSc

Epidemiologist, Institute for Clinical Evaluative Sciences

Beatrix Ko, BSc

Former Research Coordinator, The POWER Study,

St. Michael’s Hospital


Project Director, The POWER Study,

Keenan Research Centre in the Li Ka Shing Knowledge

Institute, St. Michael’s Hospital


Associate Professor, Faculty of Medicine,


Echo’s Ontario Women’s Health Council Chair in

Women’s Health, University of Toronto and Keenan

Research Centre in the Li Ka Shing Knowledge Institute,


Scientist, Keenan Research Centre in the Li Ka Shing

Knowledge Institute, St. Michael’s Hospital

CHAPTER 9—dIAbETES Gillian L. Booth, MD, MSc, FRCPC

Associate Professor, Department of Medicine,




Staff Endocrinologist, St. Michael’s Hospital

Adjunct Scientist, Institute for Clinical Evaluative Sciences

Lorraine L. Lipscombe, MD, MSc, FRCPC

Staff physician, Division of Endocrinology and

Metabolism, Women’s College Hospital

Research Scientist, Women’s College Research Institute

Assistant Professor, Department of Medicine,


Adjunct Scientist, Institute for Clinical Evaluative Sciences

Authors’ Affiliations

iii Project for an Ontario Women’s Health Evidence-Based Report (POWER) Study

iv



Onil Bhattacharyya, MD, PhD, CFPC

Assistant Professor, Department of Family and

Community Medicine,

Department of Health Policy, Management and

Evaluation, University of Toronto

Clinician Scientist, Li Ka Shing Knowledge Institute,


Denice S. Feig, MD, MSc

Associate Professor, Department of Medicine, Obstetrics

& Gynecology, and Health Policy, Management and

Evaluation, University of Toronto

Staff Endocrinologist, Head of the Diabetes

and Endocrinology in Pregnancy Program,

Mount Sinai Hospital

Baiju R. Shah, MD, PhD, FRCPC

Scientist, Institute for Clinical Evaluative Sciences

Staff Endocrinologist, Sunnybrook Health Sciences

Centre



Ashley Johns, MSc

Research Coordinator, The POWER Study,



Project Director, The POWER Study,



Beatrix Ko, BSc

Former Research Coordinator, The POWER Study,











CHAPTER 10—REPROdUCTIvE ANd GYNAECOLOGICAL HEALTHSheila Dunn, MD, MSc, CCFP(EM), FCFP

Research Director and Practitioner, Family Practice

Health Centre, Women’s College Hospital



Michelle R. Wise, MD, MSc, FRCSC

Senior Lecturer, University of Auckland

Obstetrician/Gynaecologist, Auckland Hospital

Lina M. Johnson, BScN, RN, MBA

Director Quality and Decision Support, Cambridge

Memorial Hospital

Geoffrey Anderson, MD, PhD

Professor, Department of Health Policy,

Management and Evaluation, Faculty of Medicine,


Adjunct Scientist, Institute for Clinical Evaluative

Sciences

Lorraine E. Ferris, PhD, CPsych, LLM (ADR), LLM (Admin Law)



Senior Scientist, Institute for Clinical Evaluative Sciences

Naira Yeritsyan, MD, MPH

Research Coordinator, Institute for Clinical

Evaluative Sciences

v


Ruth Croxford, MSc

Epidemiologist, Institute for Clinical Evaluative Sciences

Longdi Fu, MSc

Analyst, Institute for Clinical Evaluative Sciences


Project Director, POWER Study,












CHAPTER 11—HIv INfECTIONAhmed M. Bayoumi, MD, MSc, FRCPC

Canadian Institutes of Health Research / Ministry of

Health and Long-Term Care Applied Chair in Health

Services and Policy Research

Director, Clinical Epidemiology and Health Care

Research, Department of Health Policy,



Associate Professor, Department of Health Policy,



Scientist, Centre for Research on Inner City Health,




Project Director, POWER Study,



Robert S. Remis, MD, MPH, FRCPC



Sharon L. Walmsley, MD, MSc, FRCPC

Director, HIV Clinical Research, University Health

Network, Toronto General Hospital Division

Peggy Millson, MD, MHSc, FRCPC

Professor, Epidemiology, HIV Social, Behavioural and

Epidemiological Studies Unit, Dalla Lana School of

Public Health, University of Toronto

Mona Loutfy, MD, FRCPC, MPH



Clinician Scientist, Women’s College Research Institute,

Women’s College Hospital

Tamara Daly, MA, PhD

Assistant Professor, School of Health Policy and

Management, Faculty of Health Sciences,

York University

LaRon E. Nelson, PhD

Assistant Professor, Lawrence S. Bloomberg Faculty of

Nursing, University of Toronto

Assistant Professor of Paediatrics, Division of Adolescent

Medicine, The Hospital for Sick Children

Sandra Gardner, PhD

Scientist and Senior Biostatistician, Ontario HIV

Treatment Network

Assistant Professor, Status Only, Dalla Lana School of


Adjunct Assistant Professor, Faculty of Health Sciences,

University of Ontario Institute of Technology

Laurel Challacombe, MHSc

Manager, Research and Evaluation, Community AIDS

Treatment Information Exchange

vi



Sharmistha Mishra, MD, MSc, FRCPC, DTMH

Adjunct Lecturer, Division of Infectious Diseases, St.

Michael’s Hospital, University of Toronto

PhD candidate, Department of Infectious Diseases Epi-

demiology, Imperial College London










CHAPTER 12 — SOCIAL dETERMINANTS Of HEALTH ANd POPULATIONS AT RISk Arlene S. Bierman, MD, MS, FRCPC


Women’s Health, Lawrence S. Bloomberg Faculty of

Nursing, University of Toronto and Keenan Research

Centre in the Li Ka Shing Knowledge Institute,


Associate Professor, Nursing, Health Policy Management

and Evaluation, Medicine, University of Toronto

Ashley Johns, MSc



Brian Hyndman, MHSc

Senior Planner, Public Health Ontario

Christiane Mitchell, MPH, MAP

Research Assistant, Public Health Ontario

Naushaba Degani, MHSc, PhD

Clinical Epidemiologist, Evidence Development and

Standards, Health Quality Ontario

Project Director, POWER Study, St. Michael’s Hospital

Avram R. Shack, MA



Maria Isabella Creatore, MSc

Manager, Health Database Research Initiative/

Epidemiologist, Centre for Research on Inner City Health

PhD Candidate, Institute of Medical Sciences,


Aisha K. Lofters, MD, CCFP

Staff Physician, Department of Family/Community

Medicine, St. Michael’s Hospital

Funded Research Scholar, Department of Family and


Marcelo L. Urquia, PhD

Centre for Research on Inner City Health, The Keenan



Assistant Professor, Dalla Lana School of Public Health,


vii


Farah Ahmad, MBBS, MPH, PhD

Assistant Professor, School of Health Policy and

Management, York University

Affiliate Scientist, Centre for Research on Inner City

Health, St. Michael Hospital

Assistant Professor (status), Dalla Lana School of


Mentor, CIHR-STIHR: Health, Care, Place and Technology

(HCTP), University of Toronto

Nazilla Khanlou, RN, PhD

Echo Chair, Women’s Mental Health Research,

Faculty of Health, York University

Academic Lead, Lillian Wright Maternal Child Health

Scholars Program

Co-Director, Ontario Multicultural Health Applied

Research Network

Associate Professor, School of Nursing, York University

Vanessa Parlette, MA

PhD Candidate, Department of Geography & Planning,


CHAPTER 13—ACHIEvING HEALTH EQUITY IN ONTARIO: OPPORTUNITIES fOR INTERvENTION ANd IMPROvEMENTArlene S. Bierman, MD, MS, FRCPC


Women’s Health, Lawrence S. Bloomberg Faculty of

Nursing, University of Toronto and Keenan Research

Centre in the Li Ka Shing Knowledge Institute,


Associate Professor, Nursing, Health Policy Management

and Evaluation, Medicine, University of Toronto

Avram R. Shack, MA



Ashley Johns, MSc



viii



We wish to thank the following individuals and

organizations for their contributions to the success

of this project, and apologize in advance for any

inadvertent omissions.

AdvISORY COUNCILWe wish to thank the Advisory Council, made up of

representatives from various health care sectors and

research areas, for their strategic support and recom-

mendations on the design, implementation and

dissemination of information for the POWER Study.

Matthew Anderson, CEO, Toronto Central Local

Health Integration Network

Caroline Andrew, Chair of the Board, Echo: Improving

Women’s Health in Ontario

Adalsteinn Brown, Assistant Deputy Minister, Health

Strategy Division, Ontario Ministry of Health and

Long-Term Care

Pat Campbell, CEO, Echo: Improving Women’s

Health in Ontario

Jane Cooke-Lauder, President and CEO, Bataleur

Enterprises Inc.

Sheree Davis, Director, Health System Strategy Branch,

Ontario Ministry of Health and Long-Term Care

Marie DesMeules, Director, Innovations and Trends

Analysis Division, Public Health Agency of Canada

Kevin Glasgow, CEO, Crohn’s and Colitis Foundation

of Canada

Brian Golden, Sandra Rotman Chair in Health Sector

Strategy, University of Toronto

Lorraine Greaves, Executive Director, Health System

Strategy Division, Ontario Ministry of Health and

Long-Term Care

David Henry, President and CEO, Institute for Clinical

Evaluative Sciences

Paul Huras, CEO, Southeast Local Health

Integration Network

Andreas Laupacis, Executive Director, Li Ka Shing

Knowledge Institute, St Michael’s Hospital

Jack Lee, Senior Strategic Advisor to CMOH/ADM,

Chronic Disease Prevention and Health Promotion,

Ontario Ministry of Health Promotion

Heather Maclean, Former Director, Centre for

Research in Women’s Health

Verna Mai, Director, Screening Programs,

Cancer Care Ontario

Domenica Ozarco, Director of Strategic Policy and

Planning, Ontario Ministry of Health Promotion

Valerie Palda, Medical Director, Guidelines Advisory

Committee, Centre for Effective Practice

Indra Pulcins, Director, Indicators and Performance

Measurement, Canadian Institute for Health Information

Caroline Rafferty, Director, Quality and Performance,

Cardiac Care Network of Ontario

Jess Rogers, Director, Evidence and Guidelines, Centre

for Effective Practice

Shirlee Sharkey, President and CEO, Saint Elizabeth

Health Centre

Acknowledgements

ix


Heather Sherrard, Former Acting CEO, Cardiac Care

Network of Ontario

Vasanthi Srinivasan, Director, Health System Planning

and Research Branch, Ontario Ministry of Health &

Long-Term Care

Lisa Watson, Former Director, Strategic Policy and

Planning Branch, Ontario Ministry of Health Promotion

Lynn Wilson, Associate Professor and Chair,

Department of Family and Community Medicine,


Ruth Wilson, President, College of Family Physicians

of Canada

STAkEHOLdERSWe wish to thank our many stakeholders from across the

community for their invaluable input to the project via

roundtable discussions and additional communications.

We would like to thank all participants in the POWER

Summit who provided critical feedback on the POWER Study’s

Leading Set of Health Equity Indicators and the common

themes that emerged across POWER Study chapters.

TECHNICAL ExPERT PANELSWe wish to thank the individuals who provided their

time and expertise in the indicator selection process.

Chapter 8—Musculoskeletal Conditions

Lucie Brosseau, PhD

University Research Chair;

Professor, Physiotherapy Program;

School of Rehabilitation Sciences, Faculty of Health

Sciences, University of Ottawa

Andrea Furlan, MD, PhD

Associate Scientist, Institute for Work and Health

Claudia Lagacé, MSc

Senior Epidemiologist, Public Health Agency of Canada

Sydney Lineker, BScPT, MSc

Director of Research, the Arthritis Society,

Ontario Division

Danielle McCormack, BSc PT

Physical Therapist, the Arthritis Society

Mandy McGlynn, BSc PT, MSc

Advanced Practice Leader, Musculoskeletal

Rehabilitation Program, Toronto Rehabilitation Institute

Janet Pope, MD, MPH, FRCPC

Associate Professor of Medicine, Department of

Epidemiology & Biostatistics, University of Western

Ontario Rheumatology Centre, St. Joseph’s Hospital

Cecil Rorabeck, MD, FRCSC

Vice-President (Education), Royal College of Physicians

and Surgeons of Canada;

Orthopaedic Surgeon, London Health Sciences Centre;

Professor of Orthopaedic Surgery, University of

Western Ontario

Jo-Anne Sobie

Executive Director, The Arthritis Society, Ontario Division

Paula Stern, BSc, DC, FCCS(C)

Director, Graduate Education, Canadian Memorial

Chiropractic College

Peter Tugwell, MD

Canada Research Chair in Health Equity;

North American Editor, Journal of Clinical Epidemiology;

Professor, Medicine, and Epidemiology & Community

Medicine at the University of Ottawa;

Rheumatologist, Ottawa Hospital;

Director, Centre for Global Health in the Institute of

Population Health, University of Ottawa

x



Chapter 9—diabetes

Alice Y.Y. Cheng, MD, FRCPC

Endocrinologist, Credit Valley Hospital;

Endocrinologist, St. Michael’s Hospital;



Jeannette Goguen, MD




Irene M. Hramiak, MD, FRCP(C)

Chair, Division of Endocrinology & Metabolism,

University of Western Ontario;

Medical Director, Lawson Diabetes Center in London,

Ontario;

Professor at Schulich School of Medicine,

University of Western Ontario

Erin Keely, MD, FRCPC

Chief, Division of Endocrinology/Metabolism,

The Ottawa Hospital;

Professor, Departments of Medicine and Obstetrics/

Gynecology, University of Ottawa

Catherine Kelly, MD, FRCPC, MSc

Endocrinologist, Women’s College Hospital;



Carolyn Lawton, RN MScN ACNP CDE

Diabetes Nurse Educator and Practitioner,

Diabetes Health Centre at Sunnybrook Health

Sciences Centre

Marianne Sigmond, RN, MN, CDE

Clinical Nurse Specialist in Diabetes,

University Health Network

Karen Tu, MD, CCFP, MSc


Community Medicine, University of Toronto;

Researcher at the Family Healthcare Research Unit,

University Health Network;

Staff Family Physician, University Health Network

Afshan Zahedi, MD, FRCPC

Endocrinologist, Women’s College Hospital;

Assistant Professor, Faculty of Medicine,


Chapter 10—Reproductive and

Gynaecological Health

Wendy Katherine

Manager, Population Health and Integration Strategy,

Health System Strategy Division, Ontario Ministry of

Health and Long-Term Care

Rosana Pellizzari, MD, CCFP, MSc, FRCPC

Medical Officer of Health, Peterborough County-City

Health Unit

Jim Bottomley, BScH, MHA

Program Coordinator, Information Services,

Children’s Hospital of Eastern Ontario

Deborah A. Penava, MD, FRCSC, MPH, BA

University of Western Ontario, Associate Professor,

Department of Obstetrics and Gynaecology

Cheryl Levitt, MBBCh, CCFP, FCFP

Professor, Department of Family Medicine,

McMaster University

Erica Weir, MD, MSc, CCFP, FRCPC

Associate Medical Officer of Health, Community and

Health Services, Regional Municipality of York

xi


Elyse Lackie, MD, FRCSC

North York General Hospital, Department of Obstetrics

and Gynaecology;

Assistant Professor, University of Toronto

Sherri Deamond, MHSc

Epidemiologist, Durham Region Health Department

Chapter 11—HIv Infection

Evan Collins, MD, FRCPC

Staff Physician, Hassle Free Clinic;

Adjunct Professor, Department of Psychiatry,

University of Toronto;

Board of Directors, Ontario HIV Treatment Network

Julie Maggi, MD, FRCPC

Mental Health Services, St. Michael’s Hospital

Winston Husbands, MD

Director of Research and Program Development,

AIDS Committee of Toronto

Greta R. Bauer, PhD, MPH

Assistant Professor, Epidemiology and Biostatistics,

Schulich School of Medicine & Dentistry, The University

of Western Ontario

Curtis Cooper, MD, FRCPC

Associate Professor of Medicine, Division of Infectious

Diseases, The Ottawa Hospital, University of Ottawa

Carol Strike, PhD, MSc, BA

Research Scientist, Centre for Addiction and

Mental Health

Sara Flicker, PhD

Assistant Professor, Faculty of Environmental Studies,

York University

Anita Rachlis, MD, MEd, FRCPC

Professor of Medicine, Division of Infectious

Diseases, Sunnybrook Health Sciences Centre,


Cheryl Wagner, MD

Private practice

Chapter 12—Social determinants of Health and

Populations at Risk

As this chapter drew on indicators reported across

POWER Study chapters, we wish to thank the Technical

Expert Panel members from all POWER Study chapters.

Chapter 13—Achieving Health Equity in Ontario:

Opportunities for Intervention and Improvement

As this chapter drew on indicators reported across

POWER Study chapters, we wish to thank the Technical

Expert Panel members from all POWER Study chapters.

ExTERNAL REvIEWERSWe wish to thank the individuals who provided their time

and expertise in the external review of individual chapters.


Paula A. Rochon, MD, MPH, FRCPC

Senior Scientist, Women’s College Research Institute;

Vice President, Research, Women’s College Hospital;

Professor, Department of Medicine, University of Toronto

Dianne Mosher, MD

Division Head, Rheumatology, Department of Medicine,

University of Calgary

Linda Li, PT, PhD

Assistant Professor, Department of Physical Therapy,

University of British Columbia;

Harold Robinson/Arthritis Society Chair in

Arthritic Diseases

xii




Chaim Bell, MD, PhD, FRCPC

CIHR/CPSI Chair in Patient Safety & Continuity of Care;

Associate Professor, Departments of Medicine and

Health Policy, Management & Evaluation,


Staff Physician, St. Michael’s Hospital

Joan Canavan, RN, BN, MHA, CHE

Manager, Acute Services and Chronic Disease Unit

Provincial Programs Branch, Ministry of Health and

Long-Term Care

Alice Y.Y. Cheng, MD, FRCPC

Endocrinologist, Credit Valley Hospital;




Dr. Hertzel Gerstein, MD, MSc, FRCPC

Professor, Department of Medicine and Clinical

Epidemiology & Biostatistics; Population Health Research

Institute Chair in Diabetes (endowed by McMaster

University & Sanofi-Aventis);

Director Division of Endocrinology & Metabolism;

Deputy Director, Population Health Research Institute

McMaster University and Hamilton Health Sciences

Rick Glazier, MD, MPH, FCFP

Senior Scientist, Institute for Clinical Evaluative Sciences;

Research Scientist, Centre for Research on Inner City

Health in the Keenan Research Centre of the Li Ka Shing

Knowledge Institute at St. Michael’s Hospital;

Professor, Department of Family & Community Medicine

and Dalla Lana School of Public Health,


Stewart B. Harris, MD, MPH, FCFP, FACPM

CDA Chair in Diabetes Management;

Ian McWhinney Chair of Family Medicine Studies

Schulich School of Medicine;

Professor, Family Medicine/Epidemiology & Biostatistics,

University of Western Ontario

R. Liisa Jaakkimainen, MD, MSc, CCFP

Staff Physician, Family Practice, Sunnybrook Health

Sciences Centre;

Associate Scientist, Clinical Epidemiology Program,

Sunnybrook Research Institute;


Community Medicine, University of Toronto;

Scientist, Institute for Clinical Evaluative Sciences

Erin Keely, MD, FRCPC

Chief, Division of Endocrinology/Metabolism, The

Ottawa Hospital;

Professor, Departments of Medicine and Obstetrics/

Gynecology, University of Ottawa

Doug Manuel, MD, MSc, FRCPC

Senior Scientist, Ottawa Hospital Research Institute;

Public Health Agency of Canada / Canadian Institutes

for Health Research Chair in Applied Public Health

Sciences;

Senior Medical Advisor, Statistics Canada;

Associate Professor, Departments of Family Medicine

and Epidemiology and Community Medicine,

University of Ottawa;

Adjunct Scientist, Institute for Clinical Evaluative

Sciences

xiii


Catherine Yu, MD FRCPC MHSc

Staff, Division of Endocrinology & Metabolism,

St. Michael’s Hospital;

Assistant Professor, Faculty of Medicine and Dalla Lana

School of Public Health, University of Toronto;

Adjunct Scientist, Keenan Research Centre in the Li Ka

Shing Knowledge Institute of St. Michael’s Hospital



Kira Leeb, MSc

Director, Health System Analysis, Canadian Institute for

Health Information

Howard Berger, MD

Head, Maternal Fetal Medicine, St Michael’s Hospital,

Toronto;

Assistant Professor, University of Toronto

Anne Biringer, MD

Associate Professor, Family and Community Medicine,


Head of Primary Maternity Care, Mount Sinai Hospital

John Lamont, MD

Professor Emeritus, Department of Obstetrics and

Gynaecology, McMaster University

Guylaine Lefebvre, MD, FRCSC, FACOG

Professor, Department of Obstetrics and Gynaecology,


Past-president, Society of Obstetricians and

Gynaecologists of Canada

Debby Copes, MD

Choice in Health Clinic, Toronto

Konia Trouton, MD

Vancouver Island Women’s Clinic


Ken English

AIDS Bureau, Ministry of Health and Long-Term Care

Lisa Jackson

AIDS Bureau, Ministry of Health and Long-Term Care

Chris P. Archibald, MDCM, MHSc, FRCPC

Director, Surveillance and Risk Assessment Division,

Centre for Communicable Diseases and Infection

Control Public Health Agency of Canada


Populations at Risk

Doug Manuel, MD, MSc, FRCPC

Senior Scientist, Ottawa Hospital Research Institute;

PHAC/CIHR Chair in Applied Public Health Sciences;

Senior Medical Advisor, Statistics Canada;

Associate Professor, Departments of Family Medicine

and Epidemiology and Community Medicine,

University of Ottawa;

Associate Scientist, C.T. Lamont Primary Health Care

Research Centre and Bruyere Research Institute;

Co-lead Population Health, Population Health

Improvement Research Network;

Adjunct Scientist, Institute for Clinical

Evaluative Sciences

Chapter 13—Achieving Health Equity in Ontario:

Opportunities for Intervention and Improvement

Jane Cooke-Lauder, BA, MBA, CMC, DM

President and CEO, Bataleur Enterprises Inc.

Aura Hanna, PhD

Senior Policy Analyst, Ontario Medical Association

xiv



Adalsteinn D. Brown, DPhil

Dalla Lana Chair in Public Health Policy,


Scientist, Kennan Research Centre, Li Ka Shing


Bob Gardner, PhD

Director, Policy, Wellesley Institute

We would also like to thank all authors of previous

POWER Study chapters who reviewed the Chapter

Highlights section of chapter 13.

ACAdEMIC SUPPORT Chapter 9—diabetes

Jan Hux, MD, SM, FRCPC

Chief Operating Officer and Senior Scientist, Institute

for Clinical Evaluative Sciences;





Gita Singh, MD, MSc, FRCS(C)

Obstetrics and Gynecology, Markham Stouffville

Hospital

Guylaine Lefebvre, MD, FRCSC, FACOG

Chief, Obstetrics & Gynaecology, St. Michael’s Hospital;

Associate Professor, University of Toronto, Department

of Obstetrics & Gynaecology;

Chair, Clinical Practice Committee for the Society of

Obstetricians and Gynaecologists of Canada


Ann Burchell, PhD

Scientist and Director, Ontario HIV Treatment Network

Cohort Study

Sergio Reuda, PhD (c)

Associate Scientist & Director, Population Health &

Health Services, Ontario HIV Treatment Network

Joanne Lush

Senior Program Consultant, AIDS Bureau, Ontario

Ministry of Health and Long-Term Care


Populations at Risk

We would like to acknowledge staff from Public Health

Ontario, Health Promotion, Chronic Disease and Injury

Prevention Section, for their contribution and construc-

tive input to the content of this chapter

METHOdS WORkING GROUP Institute for Clinical Evaluative Sciences

Kinwah Fung

Alexander Kopp

Rahim Moineddin

Refik Saskin

Thérèse Stukel

Jiming Fang

Ping Li

Ruth Croxford

The POWER Study, St. Michael’s Hospital

Yingzi Li

Naushaba Degani

MAPPING GROUPCentre for Research on Inner City Health,


Peter Gozdyra

Jaeho Oh

Jonathan Weyman

xv


PROdUCTION ASSISTANCEInstitute for Clinical Evaluative Sciences

Laura Benben

Randy Samaroo

dATA PROvISION, SUPPORT & ANALYSISThe following individuals/organizations provided

invaluable information, data, support and analysis

throughout development and writing of this Report:


Jacob Cancino-Romero, Women’s College Hospital

Yingzi Li, The POWER Study, St. Michael’s Hospital


Ping Li, Senior Analyst, Institute for Clinical Evaluative

Sciences




Mark Walker, Better Outcomes and Registry Network

(BORN) Ontario’s Niday Perinatal Database

Ann Sprague, Better Outcomes and Registry Network


Huiling Cao, Better Outcomes and Registry Network



Juan Liu, Ontario HIV Epidemiologic Monitoring Unit,

Dalla Lana School of Public Health, University of Toronto

Andrew Lefebvre, Surveillance Analyst, Surveillance

Section, Public Health Protection and Prevention Branch

Public Health Division, Ontario Ministry of Health and

Long-Term Care


Emily Anne Medd, Enhanced Surveillance of Risk

Behaviours among Injection Drug Users in Canada

(I-Track) Study, Ottawa site

Greg Mitchell, Ontario Community-based HIV

and AIDS Reporting Tool (OCHART), Ontario HIV

Treatment Network

Terry Lee, Canadian Trials Network

Jason Brophy, Canadian Pediatric AIDS Research

Group, Children’s Hospital of Eastern Ontario

Alexander Kopp, Institute for Clinical Evaluative

Sciences


Populations at Risk

Yingzi Li, Data Analyst, The POWER Study,


STAff, STUdENTS ANd vOLUNTEERSThe POWER Study Team particularly wishes to thank

the following staff, students and volunteers for

their contributions:

Naushaba Degani, Project Director, The POWER Study,


Raghda Alatia, Research Coordinator, The POWER

Study, St. Michael’s Hospital

Rami Garg, Research Coordinator, The POWER Study,


Jennifer Hamilton, Research Coordinator, The POWER

Study, St. Michael’s Hospital

Gladys Honein, Doctoral Candidate, University of

Toronto

Ashley Johns, Research Coordinator, The POWER

Study, St Michael’s Hospital

Beatrix Ko, Research Coordinator, The POWER Study,

St Michael’s Hospital

Avi Shack, Research Coordinator, The POWER Study,


xvi



Deborah Tonegawa, Administrative Research

Coordinator, St. Michael’s Hospital

Tharini Tharmalingam, Research Assistant, The

POWER Study, St. Michael’s Hospital

Samantha Chin, University of Toronto

Laura Easty, McGill University

Doaa ElRouby, M.B.B.Ch, MSc, MRCP

Nidah Khan, Saba University

Thirumahal Kumarappah, University of Toronto,

Scarborough Campus

Hamsha Mahalingasivam, Faculty of Nursing,


Reva Vida Mohan, Faculty of Nursing, University of

Toronto

Anubha Momin, King’s College London

Dilisha Rodrigo, McMaster University

Sabeeka Shah, University of Toronto Scarborough

Campus

Thushara Sivanandan, University of Toronto,

Scarborough Campus

Jo-Ann Trieu, Faculty of Nursing, University of Toronto

Marlies Van Tol, Faculty of Nursing, University of

Toronto

Sunny (Yang Yang) Zhuang, University of Toronto,

Scarborough Campus

LIbRARY SUPPORTLinda Devore, Health Services Librarian, Institute for

Clinical Evaluative Sciences

kNOWLEdGE TRANSLATIONJean Kammermayer, The POWER Study,


xvii


Ontario is difficult to map as a province, due to its

vast areas in the North and detailed characteristics in

the South. As such, all maps consist of three views—

Northern Ontario, Toronto and surrounding areas, and

Southern Ontario. The measures of distance and area on

these views differ from one another.

There are two types of thematic maps in this Report that

depict a magnitude of analyzed variables: 1) bar chart

maps and 2) choropleth (shaded) maps. The following

descriptions aim to help the reader correctly view and

interpret these two map types.

bAR CHART MAPSBar chart maps can depict a variety of numeric variables

including counts and ratios across Local Health

Integration Networks (LHINs) in Ontario. In most of the

maps in this Report, the bars show values of relative risks,

odds ratios or rates (percentages).

A Guide to Reading MapsMaps are the main visual representation of spatial patterns of data and analyses covered in this Report.

The main feature to look for is the height of the bars,

since it represents the value of the mapped attribute. The

larger the attribute number (relative risk, odds ratio or

rate), the taller the bar. The number at the top or beside

each bar represents the actual value of the attribute.

If the attribute is presented in two subgroups (e.g.,

women and men) as in Figure 1, then each LHIN area on

the map has two bars. When the attribute is presented

in four subgroups (e.g., lower-education women, higher-

education women, lower-education men, and higher-

education men) as in Figure 2, then each LHIN area on

the map has four bars. In all cases, the height of the bar

is proportional to the value of the mapped attribute.

In the legend of the map the top set of bars reflects the

highest observed value in the depicted data set. This can

be used for visual comparison with the bars on the map.

The bottom set of bars shows the overall Ontario values

of the depicted attributes and can be also compared

visually to the bars on the map.

24

20

21

16

Ottawa

Kingston

11

10

9

13

12

Peterborough

251917

Barrie

8

7

London

Toronto

Hamilton

eOrangeville

MississaugaKitchener6

53

2

4

24

24

19

19

25

16

Windsor

1

L A K E O N T A R I O

L AK

E

HU

RO

N

L A K E E R I E

N

N

23

Markham

0 100 Km50

SouthernOntario

19

20

16

1622

3

5

8

6

Kitchener

Orangeville

Toronto

Mississauga

7

Markham

27

17

0 20 40 Km

2331

16

Toronto and surrounding areas

Sudbury

Thunder Bay

28

32

16

23L A K E

N I P I G O N

0 250 500 Km

13

14

NorthernOntario

L A K E S U P E R I O R

H U D S O N BA

Y

Note: See Appendix 3.3 for definitions of annual household income categories

In Ontario, 24% of women and 18% of men reported having lower annual household income.

Overall Ontario

18%24%

Data Source: Canadian Community Health Survey (CCHS) Cycle 3.1

Women (%) Men (%)

Lowerincome

Lowerincome

38

32

28

24

42

34

26

27 Ottawa

Kingston

11

10

9

13

12

Peterborough

32

24

24

2426

32

26

Barrie

8

7

London

Toronto

Hamilton

eOrangeville


53

2

4

35

3927

28

34

4025

25

35

28

34

25

Windsor

1


L AK

E

HU

RO

N

L A K E E R I E

N

27

Markham

0 100 Km50

SouthernOntario

N

24*

1722

16*

1925

1925

33*

26

32

23

3

5

8

6

Kitchener

Orangeville

Toronto

Mississauga

7

Markham

39

19

27*

22

0 20 40 Km

2828*

35*

Toronto and surrounding areas

21*

Sudbury

Thunder Bay

38

3430

24

36

4326

24

L A K EN I P I G O N

0 250 500 Km

13

14

NorthernOntario


H U D S O N BA

Y

Note: See Appendix 3.3 for definitions of annual household income categories

¥Activities at home, school or work that have been limited due to a long-term physical condition, mental condition or health problem

In Ontario, 34% of lower-income women, 25% of higher-income women, 30% of lower-income men and 23% of higher-income men reported having activity limitations.

Overall Ontario

23%

30%

25%

34%

Data Source: Canadian Community Health Survey (CCHS) Cycle 3.1

Men (%)

Women (%) Men (%)

* Interpret with caution due to high sampling variability

Lowerincome

Higher income

Lowerincome

Higher income

figure 1: Example of a Two bar Map figure 2: Example of a four bar Map

xviii



CHOROPLETH (SHAdEd) MAPSChoropleth maps use different shades or colours to

depict data values. Each colour generally represents

a range of values, as shown in the map legend. In

general, the darkness of the shade or colour is

proportional to a larger data value—the larger the

data value, the darker the shade or colour on the map.

Shaded maps usually represent rate or ratio variables

rather than raw counts or amounts.

figure 3: Example of a Choropleth Map

Ottawa

Kingston

11

10

9

13

12

PeterboroughBarrie

8

7

London

Toronto

Hamilton

eOrangeville


53

2

4

Windsor

1


L A

KE

H

UR

ON

L A K E E R I E

Markham

0 100 Km50

SouthernOntario

Sudbury

Thunder Bay

L A K EN I P I G O N

0 250 500 Km

NorthernOntario


H U D S O N BA

Y

Notes set in Frutiger 55 Roman

*extra note line set in Frutiger 55 Roman

Frutiger 65 bold.

Overall Ontario

17%

30-day mortality rate (%)11-1213-1415-1617-1819-20

ONTARIO WOMEN’S HEALTH EQUITY REPORT Volume 2 · PDF file2010 Editor: Arlene S. Bierman,...

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