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Transcript of The Manitoba RHA Indicators Atlas: Population-based comparisons of health and health care use...
The Manitoba RHA Indicators Atlas: Population-based comparisons of health and health care use
MCHP’s 10th annual Rural and Northern Health Care Day: October 7, 2003
MANITOBA CENTRE FOR HEALTH POLICY
Authors of the report:
Principal Investigator: Patricia J. Martens PhD
co-investigators:Randy Fransoo, The Need To Know Team, Elaine Burland, Laurel Jebamani, Charles Burchill, Charlyn Black, Natalia Dik, Leonard MacWilliam, Shelley Derksen, Randy Walld, Carmen Steinbach, Matt Dahl
Manitoba Centre for Health Policy
Key findings
• Heterogeneity evident throughout the province
• amongst aggregate areas (North, Winnipeg, Brandon, Rural South)
• amongst RHAs
• amongst districts within each RHA
• useful as one aspect of the Community Health Assessment process
The Need To Know Research Project #1: RHA Indicators Atlas
• districts defined by the RHAs, refined by MCPH/Manitoba Health for geo-coding
• health indicators (RHA 1999 report) reviewed and revised by NTK Team
• a longitudinal “look” (approximately 1991-1995, 1996-2000 depending on indicator)
• no matter where a person received a service, the use is attributed back to the region of residence
Non-WinnipegRHAs and districtsused in this report
(Figures 1.1, 1.2, 1.3)
The foundation of the report
• How do I interpret these numbers? • Chapter 2, plus examples in each chapter
• Who lives in my region? (age, sex, SES)• Chapter 3
• What is their overall health status?• Chapter 4 - global health status measures• Chapter 5 - selected illnesses• Chapter 7 - selected child health measures
The foundation of the report
• What are their patterns of health care use?• Chapter 6 - preventive care
• Chapter 8 - physician services
• Chapter 9 - hospital services
• Chapter 10 - surgical and diagnostic services
• Chapter 11 - home care and PCH
• Chapter 12 - pharmaceutical use
Figure 4.2.1: Premature Mortality Rates by RHA
0 1 2 3 4 5 6 7 8 9
South Eastman (1,2)
South Westman (1)
Brandon (1)
Central (1,2,t)
Marquette
Parkland
Interlake (1,t)
North Eastman (2)
Burntwood (1,2)
Churchill (1,t)
Nor-Man (1,2,t)
Rural South (t)
North (1,2,t)
Winnipeg (t)
Manitoba (t)
1991-1995
1996-2000
Mb Avg 91-95
Mb Avg 96-00
Age- & sex-adjusted rate of deaths per 1000 aged 0-74
'1' indicates area's rate was statistically different from Manitoba average in first time period shown'2' indicates area's rate was statistically different from Manitoba average in second time period shown't' indicates change over time was statistically significant
PMR 1996-2000North Eastman is 3.67 (higher than MB at 3.32)
Figure 4.2.2: Premature Mortality Rates by District
0 1 2 3 4 5 6 7 8 9
SE Northern (1,2)
SE Central (2)
SE Western
SE Southern
SW District # 3 (1)
SW District # 1
SW District # 2
Bdn West (1,2)
Bdn Rural
Bdn East
MacDonald/Cartier (2,t)
Morden/Winkler (1,2)
Altona (2,t)
Carman
Morris/Montcalm
Lorne/Louise/Pem
Seven Regions
Portage (1)
MQ District # 4
MQ District # 3
MQ District # 2
MQ District # 1
PL West
PL Central
PL East
PL North (2)
IL Southwest
IL Southeast
IL Northeast (1,t)
IL Northwest (1,t)
Springfield
Winnipeg River
Brokenhead
Iron Rose
Blue Water (2)
Northern Remote (1,2)
Thompson
Oxford H & Gods (t)
Cross Lake (2)
Lynn/Leaf/SIL
Island Lake (2)
Tad/Broch/Lac Br
Gillam/Fox Lake
Thick Por/Pik/Wab
Norway House (1,2,t)
Sha/York/Split/War (1,2)
Nelson House (1,2)
Churchill (1,t)
F Flon/Snow L/Cran (1,t)
The Pas/OCN/Kelsey (1,2)
Nor-Man Other (1,2)
1991-1995
1996-2000
Mb Avg 91-95
Mb Avg 96-00
Age- & sex-adjusted rate of deaths per 1000 aged 0-74
North Eastman (2) 3.67
From the RHA to the district levels
PMR 1996-2000
PMR 1996-2000Springfield 2.68Winnipeg River 3.08Brokenhead 3.68Iron Rose 3.38Blue Water (2) 4.33Northern Remote (1,2) 8.53 higher
average
Figure 8.3.1: Ambulatory Visit Rates by RHA
0 1 2 3 4 5 6 7
South Eastman (1,2,t)
South Westman (1,2,t)
Brandon (2,t)
Central (1,2)
Marquette (1,2,t)
Parkland (1,t)
Interlake (1,2,t)
North Eastman (1,2,t)
Burntwood (1,2,t)
Churchill (2)
Nor-Man
Rural South (1,2)
North (1,2,t)
Winnipeg (1,2,t)
Manitoba (t)
1995/96
2000/01
Mb Avg 1995/96
Mb Avg 2000/01
Age & sex adjusted rate of visits to all physicians (annual average per resident)
'1' indicates area's rate was statistically different from Manitoba average in first time period shown'2' indicates area's rate was statistically different from Manitoba average in second time period shown't' indicates change over time was statistically significant
???
Figure 8.3.1: Ambulatory Visit Rates by RHA
0 1 2 3 4 5 6 7
South Eastman (1,2,t)
South Westman (1,2,t)
Brandon (2,t)
Central (1,2)
Marquette (1,2,t)
Parkland (1,t)
Interlake (1,2,t)
North Eastman (1,2,t)
Burntwood (1,2,t)
Churchill (2)
Nor-Man
Rural South (1,2)
North (1,2,t)
Winnipeg (1,2,t)
Manitoba (t)
1995/96
2000/01
Mb Avg 1995/96
Mb Avg 2000/01
Age & sex adjusted rate of visits to all physicians (annual average per resident)
'1' indicates area's rate was statistically different from Manitoba average in first time period shown'2' indicates area's rate was statistically different from Manitoba average in second time period shown't' indicates change over time was statistically significant
South Eastman (1,2,t)
“1” = South Eastman rate (shown in grey) for the early time period is statistically different (lower) than the Manitoba overall average rate for the early time period (shown as a grey vertical line on the graph).
“2” = South Eastman rate (shown in black) for the later time period is statistically different (lower) than the Manitoba overall average rate for the later time period (shown as a black vertical line on the graph)
“t” = South Eastman earlier rate (shown in grey) is statistically different (lower) than the South Eastman later rate (shown in black).
YIKES - give me another way to understand statistical significance
0 1 2 3 4 5 6
Manitoba
Churchill
Norman
Burntwood
Interlake
North Eastman
Winnipeg
Parkland
Marquette
Central
Brandon
South Westman
South Eastman
Confidence Intervals for PMR By RHA, 1991/92-1995/96
•••
••
••
••
•
•
•
•
Adjusted Death per 1000, ages 0-74 years
0 1 2 3 4 5 6
Manitoba
Churchill
Norman
Burntwood
Interlake
North Eastman
Winnipeg
Parkland
Marquette
Central
Brandon
South Westman
South Eastman
Confidence Intervals for PMR By RHA, 1991/92-1995/96
•••
••
••
••
•
•
•
•
Adjusted Death per 1000, ages 0-74 yearsS = statistically significant from Manitoba
***
**
Rates
• Rates are age- and sex-adjusted to Manitoba 1996 population structure, with crude rates and annual numbers given in appendices
– stroke rate for Burntwood • crude rate is 1.52 per thousand
• age/sex adjusted rate is 3.2 per thousand!
Figure 3.3.9a: Age Profile of Burntwood, 2000Population: 45,051
7% 6% 5% 4% 3% 2% 1% 0% 1% 2% 3% 4% 5% 6% 7%
0-4
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80-84
90 +Burntwood 2000
Manitoba 2000
Males Females
Rates
• Each graph shows the rates by RHA/district• see the executive summary for overall rate
comparisons
• many “comparisons”• your RHA and districts within the RHA• to the Manitoba rate• your aggregate area rate (North, Rural South, Brandon,
Winnipeg)
Brandon
Marquette
Burntwood
Nor-Man
Parkland
Interlake
CentralSouthWestman South Eastman
NorthEastman
Churchill
Winnipeg
Manitoba’sRHAs(up to July 1, 2002) “North”
“Rural South”omittingBrandon andWinnipeg
Figure 4.6.1: Injury Mortality Rates by RHA
0.0 0.2 0.4 0.6 0.8 1.0 1.2
South Eastman
South Westman
Brandon
Central
Marquette
Parkland (2,t)
Interlake (1)
North Eastman (2)
Burntwood (1,2)
Churchill (s)
Nor-Man (1,2)
Rural South (2,t)
North (1,2)
Winnipeg (1,2,t)
Manitoba (t)
1990-1994
1995-1999
Mb Avg 90-94
Mb Avg 95-99
Age- & sex-adjusted rate of deaths from all injuries per 1000 residents
''1' indicates area's rate was statistically different from Manitoba average in first time period shown'2' indicates area's rate was statistically different from Manitoba average in second time period shown't' indicates change over time was statistically significant's' indicates data suppressed due to small numbers
1990-1994: 2.14; 1995-1999: suppressed
MB rate = 0.49
Rural South rate = 0.54
Prevalence
mortalitycure
Incidence
Incidence & Prevalence
Figure 11.3.1: Open Home Care Cases by RHA
0 5 10 15 20 25 30 35 40 45
South Eastman (1,2,t)
South Westman (1,2,t)
Brandon (1,2,t)
Central (1,2,t)
Marquette (1,2,t)
Parkland (1,2,t)
Interlake (1,2,t)
North Eastman (t)
Burntwood (1,2,t)
Churchill
Nor-Man (1,2,t)
Rural South (1,2,t)
North (1,t)
Winnipeg (1,2,t)
Manitoba (t)
1994/95-1995/96
1999/00-2000/01
Mb Avg 94/95-95/96
Mb Avg 99/00-00/01
Age- & sex-adjusted rate of open home care cases over period (prevalence) per 1000 residents
''1' indicates area's rate was statistically different from Manitoba average in first time period shown'2' indicates area's rate was statistically different from Manitoba average in second time period shown't' indicates change over time was statistically significant's' indicates data suppressed due to small numbers
Open homecare cases16.1 around 199521.0 around 2000
Open home care cases 16.1
Closed 6.8
New home care cases 8.0
Incidence & Prevalence
Expect anincrease in the “prevalence”, ie,open cases
Home CareCases (p.196+)
1995
And now to just a few of my favourite … graphs!
• Top causes of death (page 66)
• Top diagnoses for physician visits (page 142)
• top causes of hospitalization (page 165)
• physician visit rates by age and gender (page 132)
Heterogeneity within areas
• The need to “drill deeper” to find interesting exceptions
– the North: lower consult rates
– Churchill: highest consult rates in the province
Thompson airport
Key findings
• is your RHA missing data? Look into it!
• Heterogeneity evident throughout the province
• look for the “stories” in the data
• useful as one aspect of the Community Health Assessment process
ManitobaCentre forHealth Policy
MCHP
www.umanitoba.ca/centres/mchp/
go to Reports, or to Data Extras
Chapter links
Chapter 4: Health status and mortality
Chapter 5: The burden of illness
Chapter 6: Preventive care measures
Chapter 7: Child health indicators
Chapter 8: Physician services
Chapter 9: Hospital services
Chapter 10: Surgical procedures
Chapter 11: Home Care and PCH
Chapter 12: Pharmaceutical use