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 , depending on indicator) no matter where a person received a service, the use is attributed back to the region of residence

Non-Winnipeg RHAs and districts used 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 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) Mb Avg Mb Avg 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 North Eastman is 3.67 (higher than MB at 3.32)

North Eastman (2)3.67 From the RHA to the district levels PMR Springfield2.68 Winnipeg River3.08 Brokenhead3.68 Iron Rose3.38 Blue Water (2)4.33 Northern Remote (1,2)8.53 higher average

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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

Manitoba Churchill Norman Burntwood Interlake North Eastman Winnipeg Parkland Marquette Central Brandon South Westman South Eastman Confidence Intervals for PMR By RHA, 1991/ /96 Adjusted Death per 1000, ages 0-74 years

Manitoba Churchill Norman Burntwood Interlake North Eastman Winnipeg Parkland Marquette Central Brandon South Westman South Eastman Confidence Intervals for PMR By RHA, 1991/ /96 Adjusted Death per 1000, ages 0-74 years S = 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, 2000 Population: 45,051 7%6%5%4%3%2%1%0%1%2%3%4%5%6%7% 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 Central SouthWestman SouthEastman North Eastman Churchill Winnipeg Manitoba’s RHAs (up to July 1, 2002) “North” “Rural South” omitting Brandon and Winnipeg

MB rate = 0.49Rural South rate = 0.54

Prevalence mortality cure Incidence Incidence & Prevalence

Open homecare cases 16.1 around around 2000

Open home care cases 16.1 Closed 6.8 New home care cases 8.0 Incidence & Prevalence Expect an increase in the “prevalence”, ie, open cases Home Care Cases (p.196+) 1995

And now to just a few of my favourite … graphs! Top causes of death (page 66)page 66 Top diagnoses for physician visits (page 142)page 142 top causes of hospitalization (page 165)page 165 physician visit rates by age and gender (page 132)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

M anitoba C entre for H ealth P olicy M C H P go to Reports, or to Data Extras

Chapter links Chapter 4: Health status and mortalityHealth status and mortality Chapter 5: The burden of illnessThe burden of illness Chapter 6: Preventive care measuresPreventive care measures Chapter 7: Child health indicatorsChild health indicators Chapter 8: Physician servicesPhysician services Chapter 9: Hospital servicesHospital services Chapter 10: Surgical proceduresSurgical procedures Chapter 11: Home Care and PCHHome Care and PCH Chapter 12: Pharmaceutical usePharmaceutical use