1.0 Health Status

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1.0 Health Status

Health Conditions

1.1 Injury Hospitalization Rate

Definition
Age-standardized rate of acute care hospitalization due to injury resulting from the transfer of energy (excluding poisoning and other non-traumatic injuries), per 100,000 population.

Method of Calculation
(Total number of hospitalizations due to injury/Total mid-year population) * 100,000 (Age adjusted)

Injury is identified by any of the following external cause of injury codes with a diagnosis type of ’9’:

ICD-9
E800-E807, E810-E838, E840-E848, E880-E888, E890-E902, E906-E910, E913-E928, E953-E958, E960-E961, E963-E968, E970-E976, E978, E983-E988, E990-E998

ICD-10-CA
V01-V06, V09-V99, W00-W45, W46, W49-W60, W64-W70, W73-W77, W81, W83-W94, W99, X00-X06, X08-X19, X30-X39, X50, X52, X58, X59, X70-X84, X86, X91-X99, Y00-Y05, Y07-Y09, Y20-Y36

Interpretation
This indicator contributes to an understanding of the adequacy and effectiveness of injury prevention efforts, including public education, product development and use, community and road design, and prevention and treatment resources.

Standards/Benchmarks
Benchmarks have not been identified for this indicator.

Data Source
National Trauma Registry (NTR), CIHI.
Fichier des hospitalisations MED-ÉCHO, Ministère de la Santé et des Services sociaux.

Reference Period
April 1, 2008 - March 31, 2009.

Comprehensiveness
Available for all provinces and territories.

Comments
Poisoning, adverse effects of drugs/medicine, choking, late effects, and several other conditions do not meet the definition of trauma developed by the National Trauma Registry Advisory Committee and are therefore excluded. Newborns are also excluded.

Rates are not comparable to those appearing in the NTR annual report due to differences in the method of assigning cases to geography. The NTR data reflect region of hospitalization, while the indicator rates are based on region of residence.

1.2 Hospitalized Acute Myocardial Infarction (AMI) Event Rate

Definition
Age-standardized rate of new AMI events admitted to an acute care hospital per 100,000 population age 20 and older. New event is defined as a first-ever hospitalization for an AMI or a recurrent hospitalized AMI occurring more than 28 days after the admission for the previous event in the reference period.  

Method of Calculation
(Total number of new AMI events for persons age 20 and older) / Total mid-year population age 20 and older) * 100,000 (Age-adjusted)

Numerator Inclusion Criteria:

  1. AMI present on admission
    ICD-10-CA: I21, I22 is coded as diagnosis type (1) or
  2. Age at admission 20 years and older
  3. Gender recorded as male or female
  4. Admission to an acute care institution
  5. Canadian resident

Numerator Exclusion Criteria:

  1. Records with an invalid health card number or date of birth
  2. Records with an invalid admission date
  3. AMI admissions within 28 days after the admission date of the previous AMI hospitalization
  4. Transfers1

Interpretation
AMI is one of the leading causes of morbidity and death. Measuring its occurrence in the population is important for planning and evaluating preventive strategies, allocating health resources and estimating costs. From a disease surveillance perspective, there are three groups of AMI events: non-diagnosed events, fatal events occurring outside the hospital and those admitted to acute care hospitals. Although AMIs admitted to a hospital do not reflect all acute myocardial infarctions in the community, this information provides a useful and timely estimate of the disease occurrence in the population.

Standards/Benchmarks
Benchmarks have not been identified for this indicator.

Data Sources
Discharge Abstract Database (DAD), CIHI;
Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux.

Reference Period
April 1, 2008, to March 31, 2009. 

Comprehensiveness
Available for all provinces and territories.

Comments
This indicator includes all new hospitalized AMI events in the reference period encompassing first-ever and recurrent AMIs. A person may have more than one AMI event in the reference period. AMI events not admitted to an acute care hospital and in-hospital AMIs are not included in this indicator. 

Myocardial infarction is labelled as acute with a stated duration of four weeks (28 days) or less in ICD-10-CA and eight weeks or less in ICD-9/9-CM. Therefore, a 28-day period to define a new AMI event is applicable only to the records coded in ICD-10-CA. 

References
Heart and Stroke Foundation of Canada, The Growing Burden of Heart Disease and Stroke in Canada 2003 (Ottawa, Ont.: Heart and Stroke Foundation of Canada, 2003).

Manuel DG, Lim JJY, Tanuseputro P, Stukel TA. How many people have had a myocardial infarction? Prevalence estimated using historical hospital data. BMC Public Health 2007; 7:174.

1.3   Hospitalized Stroke Event Rate

Definition
Age-standardized rate of new stroke events admitted to an acute care hospital per 100,000 population age 20 and older.  New event is defined as a first-ever hospitalization for stroke or a recurrent hospitalized stroke occurring more than 28 days after the admission for the previous event in the reference period.

Method of Calculation
(Total number of new stroke events for persons age 20 and older) / Total mid-year population age 20 and older) * 100,000 (Age-adjusted)

Numerator Inclusion Criteria:

  1. Stroke present on admission
    ICD-10-CA: I60–I64; ICD-9-CM: 430–432; 433–434 with fifth digit of 1; 436 coded as diagnosis type (1),  or
  2. Age at admission 20 years and older
  3. Gender recorded as male or female
  4. Admission to an acute care institution
  5. Canadian resident

Numerator Exclusion Criteria:

  1. Records with an invalid health card number or date of birth
  2. Records with an invalid admission date
  3. Stroke admissions within 28 days after the admission date of the previous stroke hospitalization
  4. Transfers2

Interpretation
Stroke is one of the leading causes of long-term disability and death. Measuring its occurrence in the population is important for planning and evaluating of preventive strategies, allocating health resources and estimating costs. From a disease surveillance perspective, there are three groups of strokes: fatal events occurring out of the hospital, non-fatal stokes managed outside acute care hospitals and those admitted to an acute care facility. Although strokes admitted to a hospital do not reflect all stroke events in the community, this information provides a useful and timely estimate of the disease occurrence in the population.

Standards/Benchmarks
Benchmarks have not been identified for this indicator.

Data Sources
Discharge Abstract Database (DAD), CIHI.

Reference Period
April 1, 2008, to March 31, 2009. 

Comprehensiveness
Available for all provinces and territories, except Quebec. Rate for Quebec is not available due to differences in data collection.

Comments
This indicator includes all new hospitalized stroke events in the reference period encompassing first-ever and recurrent strokes. A person may have more than one stroke event in the reference period. Stroke events not admitted to an acute care hospital and in-hospital strokes are not included in this indicator. 

Note that identification of strokes resulting from occlusion of precerebral arteries, included in this indicator, is not possible in the ICD-9 coding system.

References
Heart and Stroke Foundation of Canada, The Growing Burden of Heart Disease and Stroke in Canada 2003 (Ottawa, Ont.: Heart and Stroke Foundation of Canada, 2003).

Truelsen T, Bonita R, Jamrozik K. Surveillance of Stroke: A Global Perspective.  International Journal of Epidemiology 2001; Suppl 1: S11–S16.

Johansen HL, Wielgosz AT, Nguyen K, Fry RN. Incidence, Comorbidity, Case Fatality and Readmission of Hospitalized Stroke Patients in Canada. Canadian Journal of Cardiology 2006; 22:65–71.

World Health Organization, WHO STEPS Stroke Manual: The WHO STEPwise approach to stroke surveillance. (Geneva, World Health Organization, 2006).

1If a subsequent AMI admission occurs on the same day as the discharge date of a previous AMI admission, it is considered as a transfer.

2If a subsequent Stroke admission occurs on the same day as the discharge date of a previous Stroke admission, it is considered as a transfer.

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