chapter 5€¦ · 78.9 78.1 78.0 75.4 73.6 73.2 69.3 32.0 MOH-0004.qxd:Layout 1 12/11/08 4:06 PM...

HOW HEALTHY ARE THERESIDENTS OF PEEL?Multiple measures must be used to create a fullpicture of the health of a population. In thissection, we provide several perspectives on thehealth of Peel’s population, including self-ratedhealth, mortality, hospital discharges andemergency department visits.

It is important to keep in mind that themagnitude of disease in a population is not the only factor affecting these measures. For example, the rate of hospitalizations wouldbe affected by the prevalence of disease, but itcould also be influenced by the availability ofhospital beds and changing patterns of medicalcare, including the shift from inpatient tooutpatient care.

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chapter 5

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chapter 5 • how healthy are the residents of peel?

53

Self-rated health predicts later disability and mortality

Self-rated health is an individual’s assessment ofhis or her general health. Many studies havedemonstrated that self-rated health is animportant predictor of disability and mortality.1–6

In 2005 in Peel, 89% of residents reported thattheir health was excellent, very good or good.This is similar to the proportion in the otherregions of the Greater Toronto Area and acrossOntario as a whole. Among Peel residents, thereis no difference by sex in self-rated health. Thoseaged 45 to 64 years and 65 years and older areless likely than younger age groups to report thattheir health is excellent, very good or good(Figure 5.1).C

The number of chronic conditions a person has increases with age

Forty-seven per cent of Peel residents reporthaving at least one chronic condition. This figureis significantly lower than Ontario’s rate of 52%.In both Peel and Ontario, the number of chronicconditions reported is strongly related to age.Among Peel residents aged 65 years and older,

87% have at least one chronic condition (Figure 5.2 on next page).C

A chronic condition is defined as acondition lasting, or expected to last, at least six months and which has been diagnosed by a health professional.

Figure 5.1Self-Rated Health† by Age Group,Peel, 2005

Age group (years) 12-19

† Defined as excellent, very good and goodSource: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care

Per cent of population aged 12 years and older94.4

20-44

93.4

45-64

84.7

65+

71.0

0

20

40

60

80

100


Figure 5.3 shows the common chronic conditionsreported by Ontario residents.

Hearing and vision problems are common in the elderly

In 2003, 11% of Canadian seniors reported thatthey had a hearing problem. Self-reportedhearing problems among seniors increased withage from 5% of those aged 65 to 69 years to 23% of those aged 80 years and older.

a comprehensive report on health in peel

54

Figure 5.2Population with at Least One Self-Reported Chronic Condition†,Peel and Ontario, 2005

Per cent of population aged 12 years and older

Age group (years)12-19 20-44 45-64 65+

Peel Ontario

† Diagnosed by a health care professionalSource: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care

16.521.4

36.939.4

65.7 66.3

87.1 87.8

0

20

40

60

80

100


Back ProblemsArthritis and Rheumatism

High Blood PressureAsthma

Mood DisorderThyroid

DiabetesHeart Disease

Cataracts††

Anxiety DisorderBowel Disorder

UlcersBronchitis

CancerGlaucoma††

Effects of a StrokeCOPD†††

Emphysema†††

EpilepsyAlzheimers/Dementia††

Eating DisorderSchizophrenia

Figure 5.3Prevalence of Selected Self-Reported Chronic Conditions†,Ontario, 2005

† Diagnosed by a health care professional†† Among the total population 18 years and older††† Among the total population 30 years and olderSource: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care

0 5 10 15 20 25

19.517.2

15.48.0

6.05.3

4.84.8

4.54.3

4.1

1.51.5

0.70.7

0.50.40.30.3

1.1

3.12.4


Hearing problems were more prevalent amongmale seniors than female seniors (12% vs. 9%).7

In 2003, about half of the Canadian populationhad some type of vision problem. The mostserious problems were experienced by olderadults. Vision problems were reported by 82% ofCanadian seniors. A similar proportion wasreported for Ontario. Seventy-eight per cent ofCanadian seniors with vision problems reportedthat their difficulties had been corrected (forexample, with glasses or contact lenses), while4% reported “uncorrected” problems (includingproblems not amenable to correction).8 Twenty-five per cent of falls causing injury amongseniors are attributed to vision problems.9

The three most common causes of visionproblems are cataracts, glaucoma and age-relatedmacular degeneration.

The prevalence of cataracts increases with ageand has increased over time in Canada.8 In 2005,24% of Ontario seniors and 20% of Peel seniorsreported being diagnosed with cataracts by ahealth care professional.C

According to the Canadian National Institute forthe Blind, one million Canadians are affected bysome form of age-related macular degeneration.With the expected aging of the population, thenumber of Canadians affected by age-relatedmacular degeneration is expected to doublewithin the next 25 years.10

In 2003, 6% of Canadian seniors reported beingdiagnosed with glaucoma by a health careprofessional, with the prevalence being higheramong women.8 In Ontario, the prevalence ofglaucoma increases with age (Figure 5.4).C


55

Figure 5.4Prevalence of Cataracts and Glaucoma† by Age Group,Ontario, 2005


Age group (years)18–49 50–64 65–74 75+

Cataracts Glaucoma

† Diagnosed by a health professional* Use estimate with cautionSource: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care

0.5* 0.3*

4.22.0

18.6

4.5

30.3

8.7

0

5

10

15

20

25

30

35


BURDEN OF DISEASE

In this section, seven selected health conditionswere examined and compared to illustrate theburden of chronic conditions in Ontario and thecorresponding burden of mortality, hospitaliza-tions and emergency department visits. Thesehealth conditions displayed some or all of the following characteristics: they were highly prevalent, caused many deaths, led to long hospital stays, resulted in many emergencydepartment visits or had large direct or indirecthealth care costs. The health conditions examined were:

• Cardiovascular disease • Cancer (all types combined)• Diabetes• Injuries, accidents and suicides• Arthritis and rheumatism• Respiratory disease (asthma and chronic

obstructive pulmonary disease)• Mental health disorders (schizophrenia and mood

disorders)

Figure 5.5 shows that each condition or diseasehas a different profile in terms of prevalence,mortality, hospitalizations and emergencydepartment visits. Cardiovascular disease, which includes ischaemic heart disease andstroke (cerebrovascular disease), had the highestmortality rate and high rates of hospitalizationand emergency department visits, while cancerhad the highest rate of premature death. Thecategory of injuries, accidents and suicides had a relatively low rate for mortality, but high ratesfor premature death, hospitalizations andemergency department visits. For mental healthdisorders and respiratory disease, the rates forhospitalizations and emergency department visitswere higher than those for mortality. Fordiabetes, the rates for mortality, hospitalizationsand emergency department visits were relativelylow, but the associated illnesses, such ascardiovascular disease, have a much moresignificant impact.


56

Figure 5.5Burden of Selected Health Conditions,

Ontario, 2004, 2005, 2006

Mortal

ity Ra

te - 2

004 (

per 10

0,000

)

PYLL

†† Rate

- 200

4 (per

100,0

00)

† Diagnosed by a health care professional†† PYLL = Potential Years of Life LostSources: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term CareOntario Mortality Database 2004, HELPS (Health Planning System), Ministry of Health PromotionHospital In-Patient Discharges Data 2005 and Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term CareNational Ambulatory Care Reporting System 2006

Hospita

lizatio

n Rate

- 200

5 (per

100,0

00)

ED Visit

Rate

- 200

6 (per

100,0

00)

Preva

lence

-200

5 (per

100,0

00)

Cardiov

ascu

lar

diseas

e

Cance

r (all)

Diabete

s

Injuri

es, a

cciden

ts

and su

icides

Arthrit

is an

d

rheum

atism

Respira

tory

diseas

e

Mental

healt

h

disord

ers0

200

400

600

800

1000

1200

1400

177.

071

2.4

936.

01,

164.

6

5,60

0.0

168.

91,

339.

5

416.

710

2.9

1,50

0.0

20.7

108.

5 88.1 189.

14,

800.

033

.583

6.6

1,18

9.6

11,0

01.1

1,40

7.8

13,6

00.0

2.6 20

.029

0.3

17,2

00.0

21.2 56

.524

5.0

1,09

2.7

8,60

0.0

0.5 3.

925

6.2 37

3.4

6,10

0.0

MOH-0004.qxd:Layout 1 12/11/08 4:06 PM 6

Canadians have a life expectancy of 81.2 years atbirth (Figure 5.6).

Within Canada, the province of British Columbiahas the highest life expectancy at birth for bothmales and females. Males in British Columbiaare expected to live almost three years longerthan their counterparts in Newfoundland andLabrador. In all provinces, females are expectedto live longer than males.

Life expectancy in Canada increased at firstbecause of a dramatic fall in infant mortality;more recently, the increase has resulted fromreduced mortality rates among older age groups(Figure 5.7).

In 2004 in Peel, life expectancy at birth was 84.1years for females and 80.2 years for males. InOntario, life expectancy was lower at 82.6 yearsfor females and 78.2 years for males. Between1986 and 2004 in Peel and Ontario, lifeexpectancy increased for both males and females.The improvement in life expectancy was greaterfor males than females, thus reducing the gapbetween the sexes. Life expectancy in Peel isconsistently higher than in Ontario.

Historic Life Expectancy in Canada

The life expectancy of Canadians hasbeen continually increasing. Femaleshave a longer life expectancy thanmales. The gap between males andfemales was particularly wide until1982, but the difference hasdecreased since then.

?Life expectancy estimates the averageage at death for a group or cohort atbirth. Life expectancy is calculatedbased on the current mortality ratesexperienced by all age groups in thepopulation.


57

Canada

Japan

United Kingdom

Italy

Portugal

United States

Jamaica

Poland

India

China

Swaziland

Figure 5.6Life Expectancy at Birth,Selected Countries, 2008

Source: CIA World Factbook, 2008, available at: https://www.cia.gov/library/publications/the-world-factbook/rankorder/ 2102rank.html

0 20 40

Life expectancy (years)

60 80 100

82.1

81.2

80.1

78.9

78.1

78.0

75.4

73.6

73.2

69.3

32.0


Health: Quantity and Quality

Life expectancy is a measure of expected lengthof life. Health-adjusted life expectancy (HALE)is a more comprehensive indicator that takes intoaccount quality of life. Years lived in poor healthare counted as equivalent to only part of a fullyear of good health.

In Peel in 2004, HALE was 73.9 years for malesand 76.3 years for females. Although females areexpected to live more years in poor health, theyalso live more of their years in good health,compared to their male counterparts (Figure 5.8).


58

Figure 5.8Life Expectancy at Birth and Health-Adjusted Life Expectancy (HALE),Peel, 1986–2004

Year

1986 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 20041987

Source: Ontario Mortality Database 1986-2004, HELPS (Health Planning System), Ministry of Health PromotionPopulation Estimates 1986-2004, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care

Life Expectancy Males Life Expectancy Females HALE Males HALE Females

Age in years

0

60

70

80

90

100

Figure 5.7Life Expectancy at Birth by SexCanada, 1920–2002

Year

1920–22 1930–32 1940–42 1950–52 1960–62 1970–72 1980–82 1990–92 2002

Sources: Statistics Canada, Available at: http://www40.statcan.ca/l01/cst01/health26.htmSt-Arnaud J, Beaudet M, Tully P. Life Expectancy. Health Reports 17(1):43-47. 2005

Males Females

0

10

20

30

40

50

60

70

80

90Age in years


Disability Among Peel residents in 2005:

• Ten per cent “often” experienced an activitylimitation at home, school, work or otherlocation, and 16% “sometimes” experienced suchan activity limitation.

• Eleven per cent needed assistance with activitiesof daily living.

• Nine per cent had stayed in bed or cut down onnormal activities in the previous two weeks dueto illness or injury. Of those 9%, over two thirdsof residents reported staying in bed or cuttingdown on their normal activities for three days orless in the previous two weeks.

• Females were more likely to report all threemeasures of disability than males (Figure 5.9).C

Increasing age is accompanied by an increase inactivity limitation and in the need for assistancewith the activities of daily life (Figure 5.10 onnext page). By age 65 years and older, half ofPeel residents have an activity limitation andalmost one third require assistance with theactivities of daily living. As the population ofPeel ages, the proportion of residents reporting adisability will increase, and the need for assistiveprograms and services will rise accordingly.

Activity restriction is defined as beinglimited in activities (including at home,school and work) due to a physicalcondition, mental condition or healthproblem that had lasted, or wasexpected to last, six months or longer.

The need for assistance with the activities of daily living is defined asreporting the need of assistance fromanother person to carry out activitiesassociated with daily living, such aspersonal care (washing, dressing, eating), moving about inside the house or instrumental activities (mealpreparation, shopping, normal housework).

Two week disability is defined as having stayed in bed or cut down onnormal activities one or more days inthe previous two weeks due to illnessor injury.


59

Figure 5.9Activity Limitations by Sex,Peel, 2005


Activity Limitation(Often + Sometimes)

Needs Assistance with Activitiesof Daily Living

Two Week Disability

Male Female

Source: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care

23.0

29.4

6.4

16.0

5.2

12.6

0

5

10

15

20

25

30

35


Mortality

In Ontario between 1922 and 2004, the crudemortality rate decreased. Throughout this period,females experienced a lower crude mortality ratethan males (Table 5.1).

In Peel between 1986 and 2004, the age-standardized mortality rate also decreased(Figure 5.11 on next page). Peel’s age-standardized mortality rate has been consistentlylower than Ontario’s.

The crude mortality rate is the totalnumber of deaths divided by the totalpopulation, usually expressed per100,000 population.

The age-standardized mortality rate isa calculation that allows for compar-isons between populations and overtime. Age-standardized rates are morecomparable because differences in agedistribution have been removed.


60

Figure 5.10Activity Limitation by Age Group,Peel, 2005


Activity Limitation(Often + Sometimes)

Needs Assistance with Activitiesof Daily Living

Age group (years)

Two Week Disability

12–19 20–44 45–64 65+

Source: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care

16.819.3

34.1

51.0

2.67.6

14.7

31.5

6.9 8.210.5 10.6

0

10

20

30

40

50

60

Table 5.1Crude Mortality Rates† by Sex,Ontario, 1922–2004

† Rate per 1,000 populationSources: 1922, 1947, 1960, 1989 Vital Statistics, Office of the Registrar GeneralOntario Mortality Database 2004, HELPS (Health Planning System), Ministry of Health Promotion

1922 1947 1960 1989 2004

Male 11.8 10.8 9.6 8.0 6.8

Female 11.1 9.0 7.3 6.9 6.6


Figure 5.12 shows the age-specific mortality ratesfor males and females in Peel. Typically, mortalityrates for both sexes are high at birth and decline inearly childhood. From ages 10 to 35 years, risk-taking behaviour causes males to have a highermortality rate than females – for the most partthese deaths are preventable.

Figure 5.13 (next page) shows the age-standardized mortality rates for selected causes inOntario from 1969 to 2000. For certain causes,like ischaemic heart disease, the mortality ratehas decreased dramatically.


61

Figure 5.11Mortality Rates by Sex,Peel, 1986–2004

Year1995 1996 1997 1998 1999 2000 2001 2002 2003 20041986 1987 1988 1989 1990 1991 1992 1993 1994


Male Female

0

200

400

600

800

1,000Age-standardized number of deaths per 100,000 population

Figure 5.12Age-Specific Mortality Rates by Sex,Peel, 2004

Age group (years)<1 1-4 5-9 15-1910-14 20-24 25-29 30-34 40-4435-39 45-49 50-54 55-59 60-64 70-7465-69 75-79 85-8980-84 90+

Source: Source: Ontario Mortality Database 2004, HELPS (Health Planning System), Ministry of Health PromotionPopulation Estimates 2004, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care

Male Female

1

10

100

1,000

10,000

100,000Number of deaths per 100,000 population in logarithmic scale


In 2004, the leading causes of death in Peel wereischaemic heart disease, lung cancer, and stroke

Very few deaths occur among children under theage of 19 years. The majority of deaths occuramong residents aged 65 years and older, with

ischaemic heart disease, stroke (cerebrovasculardisease) and lung cancer being the most commoncauses. Suicide and land transport accidents arethe most common causes of mortality amongthose aged 20 to 44 years (Figure 5.14).


62

Figure 5.14Most Common Causes of Death by Age Group,Peel, 2000–2004 Combined


0 to 19 years:Perinatal conditionsCongenital anomaliesLand transport accidentsAll other causes

65+ years:Ischaemic heart diseaseStrokeLung cancerAll other causes

20 to 44 years:SuicideLand transport accidentsIschaemic heart diseaseAll other causes

45 to 64 years:Ischaemic heart diseaseLung cancerBreast cancerAll other causes

2.8%

6.0%

20.1%

71.1%

Figure 5.13Mortality Rate for Selected Causes,Ontario, 1969–2000

Year

Source: Chronic Disease Infobase, Public Health Agency of Canada, Available at: http://204.187.39.30/surveillance/ Mapdb/Infobase_e.htm

Cancer Ischaemic heart disease Stroke Diabetes Injury and poisoning

400

350

300

250

200

150

100

50

0

1969

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

Age-standardized number of deaths per 100,000 population


Dying Young In Peel in 2004, cancer was the leading cause ofpotential years of life lost (Figure 5.15). Injuriesand accidents, ischaemic heart disease andsuicide were the next most common causes ofpotential years of life lost.

Ischaemic heart disease was the leading cause ofpremature death among males, while breastcancer was the second leading cause amongfemales (Table 5.2 on next page). Althoughdeaths due to perinatal conditions were few innumber in Peel in 2004, they are an importantcontributor to PYLL due to the strong influenceof the 75 years of life lost in each case.

The number of potential years of lifelost (PYLL) is a measure of prematuredeath. It is the sum of all the yearsnot lived by all the individuals in apopulation who die prior to age 75.PYLL weights death at a young age more heavily than death at anolder age.


63

Figure 5.15Potential Years of Life Lost by Selected Causes,Peel, 2004

Per cent of total potential years of life lost

† Many deaths associated with diabetes have ischaemic heart disease or renal failure recorded as the cause of death†† COPD – Chronic Obstructive Pulmonary DiseaseSource: Ontario Mortality Database 2004, HELPS (Health Planning System), Ministry of Health PromotionPopulation Estimates 2004, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care

Ischaemic heart disease

Injuries and accidents

Suicide

Stroke

Diabetes†

Asthma and COPD††

All others

Cancer

0 5 10 15 20 25 30 35 40

32.5

10.9

8.4

5.5

2.6

1.6

1.0

37.4


Going to Hospital

In Peel in 2005 the number of hospitalizationsamong females was substantially higher thanamong males (Table 5.3 and 5.4 on next page).This can be explained by the large number of hospitalizations related to pregnancy and childbirth.

Peel residents are less likely than their Ontariocounterparts to visit an emergency department

The emergency departments in Peel hospitalsprovide emergency and non-urgent care to a highvolume of patients of all ages with a wide range

of conditions. In 2006, Peel residents made286,530 emergency department visits (Table 5.5on page 66). The rate of emergency departmentvisits for males and females in Peel werecomparable. Peel residents were much less likely than their Ontario counterparts to visit an emergency department. This pattern might be explained by regional variations in theavailability of physicians, walk-in clinics and/orurgent care centres.

Rates of emergency department visits are highestin the older age groups and among childrenyounger than 10 years of age.


64

Table 5.2Potential Years of Life Lost by Selected Causes by Sex,Peel, 2004

Source: Ontario Mortality Database 2004, HELPS (Health Planning System), Ministry of Health Promotion

MALES # PYLL FEMALES # PYLL

Ischaemic heart disease 2,608 Perinatal conditions 1,875

Perinatal conditions 2,014 Breast cancer 1,616

Intentional self-harm 1,530 Congenital malformations, deformations, & chromosomal abnormalities 1,069

Land transport accident 1,494 Lung cancer 981

Lung cancer 1,352 Ischaemic heart disease 685

Cancer of the lymph,blood & related tissues 902 Intentional self-harm 602

Colorectal cancer 771 Cancer of the lymph, blood & related tissue 587

Stroke 627 Colorectal cancer 559

Congenital malformations,deformations, & chromosomalabnormalities 621 Stroke 401

Cirrhosis and otherdiseases of liver 607 Ovarian cancer 322

All other causes 11,056 All other causes 6,720

All causes 23,582 All causes 15,417



65

Table 5.3Hospital Discharges for Females,Peel, 2005

† Puerperium defined as the period immediately after childbirthNote: Sex information was unknown for 28 hospitalizationsSource: Hospital In-Patient Discharge Data 2005, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care

Selected Cause Number Total # of days

Conditions associated with pregnancy, childbirth and the puerperium† 15,350 35,269

Injury and poisoning 2,132 14,807

Arthritis/Rheumatism 1,561 8,587

Ischaemic heart disease 1,125 7,707

Chronic obstructive lung disease 1,064 6,882

Mood disorder 811 11,953

Pneumonia and influenza 646 4,106

Heart failure 629 5,703

Short gestation and low birth weight 597 7,987

Pregnancy with abortive outcome 587 814

All other causes 19,698 121,580

All causes 44,200 225,395

Table 5.4Hospital Discharges for Males,Peel, 2005

Note: Sex information was unknown for 28 hospitalizationsSource: Hospital In-Patient Discharge Data 2005, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care

Selected Cause Number Total # of days

Ischaemic heart disease 2,555 14,792

Injury and poisoning 2,422 14,178

Chronic obstructive lung disease 1,157 6,070

Arthritis/Rheumatism 1,120 4,871

Short gestation and low birth weight 731 10,575

Pneumonia and influenza 678 4,359

Hernia 597 1,972

Heart failure 596 5,669

Stroke 593 7,200

Diseases of appendix 543 1,392

Other causes 18,141 124,291

All Causes 29,133 195,369


In Peel in 2006, injuries and poisonings were theleading cause of emergency department visits,followed by arthritis and rheumatism and chronicobstructive lung disease (Table 5.5).

Among children and youth, the most commoncauses of emergency department visits wereinjuries and poisonings, diseases related to theear, and respiratory conditions. Injuries andpoisonings are the cause of almost 40% ofemergency department visits by children agedone to 19 years (Table 5.6).


66

Table 5.6Emergency Department Visits among Children Aged One to 19 Years,Peel, 2006

Source: National Ambulatory Care Reporting System Data 2006, Provincial Health Planning Database (PHPDB),Ontario Ministry of Health and Long-Term Care

Cause Number

Injury and poisoning 26,561

Diseases of the ear and mastoid process 2,811

Chronic obstructive lung disease 2,811

Arthritis and rheumatism 1,126

Pneumonia and influenza 1,111

Acute bronchitis and bronchiolitis 793

All other causes 34,901

All Causes 70,114

Table 5.5Emergency Department Visits,Peel, 2006

Source: National Ambulatory Care Reporting System Data 2006, Provincial Health Planning Database (PHPDB),Ontario Ministry of Health and Long-Term Care

Cause Number

Injury and poisoning 80,304

Arthritis and rheumatism 8,870

Chronic obstructive lung disease 7,154

Pneumonia and influenza 3,214

Ischaemic heart disease 2,312

All other causes 184,676

All causes 286,530


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