Community Health Status Report 2014

i HOW TO OBTAIN MORE INFORMATION

Inquiries about this report should be directed to the Porcupine Health Unit, Gary Schelling, Communications Specialist, by mail:

Porcupine Health Unit 169 Pine Street South Postal Bag 2012 Timmins, ON P4N 8B7

Or by phone,

Local Phone: 1.705.267.1181 Toll Free: 1.800.461.1818

Or by email, e-mail: [email protected]

This report is also available in electronic format, free of charge. To obtain a copy, please visit our website at www.porcupinehu.on.ca Community Health Status Report 2014

Foreword

It is with great pleasure that the Porcupine Health Unit releases this 2014 Community Health Status Report. A core function of public health is population-wide health assessment. This includes the examination of trends in particular diseases and the risk factors for those diseases. This report looks at a wide number of community health indicators. It contains statistical information that is reflective of national and provincial trends, as well as information that is uniquely reflective of specific health challenges in our health unit area.

The Porcupine Health Unit is responsive in its programming to evolving health issues as identified in health status reports such as this one. We also hope this information will be useful to our many health partner organizations and will assist them in their planning efforts.

We wish to acknowledge the support of the Porcupine Health Unit’s management team in the production and development of this report. We would also like to recognize the gracious epidemiologic support we received from Public Health Ontario’s Epidemiology Unit, namely, Jeremy Herring and Ruth Sanderson.

Sincerely,

______

Dr. Rosemarie Ramsingh, Councillor Gary Scripnick, Medical Officer of Health, Board of Health Chair, Porcupine Health Unit Porcupine Health Unit

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Community Health Status Report 2014

HIGHLIGHTS OF THIS REPORT

Demographics and Socioeconomics: The Porcupine Health Unit (PHU) is one of the most geographically large health units in the province of Ontario. It is located in Northeastern Ontario. It has many demographic and socioeconomic factors that make it unique in the province.

As compared to the entire province of Ontario, the PHU area has:

• A higher Francophone population (45.9% versus 4.1%); • A higher Aboriginal population (12.3% versus 2.0%); • A lower population density (0.3 people/km2 versus 14.1 people/ km2); • A similar unemployment level (7.4% versus 7.8%); • A higher percentage of those not completing high school (34% versus 22%); and • A higher cost of nutritious food (the cost of the standardized Nutritious Food Basket is $14.88 higher in the PHU than the Ontario cost).

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Some Encouraging Findings: Self-reported measures of personal well-being are higher among residents of the PHU area, compared to the province while lower levels of stress are reported. For some key health indicators and screening indicators, the findings below were encouraging as well.

In comparison to the province of Ontario, the PHU area has:

• Very similar levels of self-reported community belonging (67.9% versus 67.5%); • Very similar levels of self-reported life satisfaction (92.9% versus 91.8%); • Very similar levels of self-reported stress (22.2% versus 22.8%); • Only slightly lower levels of self-reported good mental health (69.6% versus 72.4%); • Very similar rates of self-reported seat belt use (94.2% versus 95.1%); • Higher levels of self-reported mammography screening (recently 80.4% versus 73.2%); • Lower rates of reportable enteric diseases (e.g., gastro-intestinal illness); • Lower rates of tuberculosis (1 per 100,000 versus 4.9 per 100,000); and • A significant trend towards less youth smoking (65% of youth never smoked a whole cigarette in 2007/8 and 83% of youth have never smoked a whole cigarette in 2009/10).

Some Challenging Findings: The Porcupine Health Unit area has some indicators that reflect some major challenges in the area of health. As compared to the whole of the province, the PHU area has:

• A lower life expectancy, 4 years less for men and 3.3 years less for women; • A higher rate of potentially-avoidable mortality (e.g., deaths likely caused by smoking, excess drinking, and other lifestyle activities), 1.6 times higher;

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• A higher cancer rate, 1.25 times higher; • A higher rate of alcohol-related deaths, 2 times higher; • A higher rate of death and/or hospitalization for a number of diseases associated with lifestyle risk factors (e.g., heart disease, chronic obstructive lung disease, diabetes, and arthritis); • A higher rate of hospitalization due to mental illness, 3 times higher; • A higher rate of suicide (intentional self-harm), 3 times higher (further, among those 10–19, it is even higher: for girls in this age group it is over 24 times higher, and for boys in this age group it is over 12 times higher); • A higher rate of infant mortality, 7.7 per 1,000 live births versus 4.9 per 1,000 live births; • A higher teen pregnancy rate (2 times higher) and a higher live birth rate to teens, over 3 times higher; • A lower breastfeeding (at time of discharge from hospital) rate, 17.6% lower; • A higher smoking rate, 1.4 times higher, and a higher rate of environmental tobacco exposure, 1.7 times higher; • Significantly higher rates of chlamydia and gonorrhea (sexually transmitted infections); • A higher rate of drinking at levels associated with negative health outcomes, 52.8% versus 41%; and • A higher rate of death due to land transport crashes, 9.6 per 100,000 versus 6.2 per 100,000.

Data Needs Identified: There is a significant gap in available data on First Nations (FN) on reserve within the Porcupine Health Unit area, and also on Aboriginal people living off-reserve within the boundaries of the health unit area. The first issue relates to FN on reserve often not participating in national surveys such as the Canadian Community Health Survey. The second issue relates to the absence of an ethnic identifier in administratively collected health data, making it impossible to do subanalyses on any ethnic population to assess any difference in prevalence or incidences in certain diseases.

Other major gaps are in the area of mental health. There is insufficient high quality data for different sub-groups to delve into for this large problem in our area.

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Table of Contents

HIGHLIGHTS OF THIS REPORT...... iii

Demographics and Socioeconomics...... iii

Some Encouraging Findings...... iv

Some Challenging Findings...... iv

Data Needs Identified...... v section 1 – DEMOGRAPHICS...... 1 section 2 – SELECTED SOCIAL DETERMINANTS OF HEALTH...... 3 section 3 – MORTALITY...... 5

Leading Causes of Death...... 5

Life Expectancy ...... 7

Potentially Avoidable Mortality ...... 8

Injury-Related Mortality...... 8

Mortality Counts and Rates for Selected Chronic Diseases ...... 12 section 4 – MORBIDITY...... 15

Self-Rated Health...... 15

Hospitalization for Selected Chronic Diseases...... 16

Prevalence for Selected Chronic Diseases...... 20

Mental Health...... 21 section 5 – RISK FACTORS...... 25

Smoking...... 25

Alcohol...... 27

Physical Activity, Nutrition and Healthy Weights...... 29

Bike Helmet Use...... 29

Seatbelt Use...... 30

High Blood Pressure...... 30 section 6 – HEALTHCARE SYSTEM INDICATORS...... 31

Regular Medical Doctor...... 31

General/Family/Specialist Physician Rate ...... 31

Wait Time for Hip Fracture Surgery ...... 32

Emergency Room Wait Times ...... 34

Repeat Hospitalizations for Mental Illnesses...... 34

Selected Screening Practices ...... 35 section 7 – REPRODUCTIVE AND CHILD HEALTH...... 37

Reproductive Health...... 37

Infant Mortality...... 40

Small & Large for Gestational Age ...... 41

Breastfeeding Intent, Initiation and Duration...... 42

Child Dental Health...... 44 section 8 – INFECTIOUS DISEASES...... 45

Selected Sexually Transmitted and Blood Borne Infections...... 45

Selected Enteric Diseases ...... 50

Selected Diseases Transmitted By Respiratory Route...... 52 section 9 – SERVICE STATISTICS SNAPSHOT...... 53

APPENDIX A – GLOSSARY...... 55

APPENDIX B – METHODOLOGY...... 67

Data Sources and Limitations...... 67

Data Analysis ...... 69

Data Comparisons...... 71

Small Counts...... 72

APPENDIX C – BIBLIOGRAPHY...... 73 Community Health Status Report 2014

section 1 DEMOGRAPHICS

The Porcupine Health Unit is a public health unit located in Northeastern Ontario serving a wide geographic area that covers the entire Cochrane District and the Town of Hornepayne. Our head office is located in Timmins, with branch offices in Cochrane, Hearst, Hornepayne, Iroquois Falls, Kapuskasing, Matheson, Moosonee and Smooth Rock Falls.

Fig. 1. Porcupine Health Unit locations

PORCUPINE HEALTH UNIT CATCHMENT AREA

Moosonee

Hearst Kapuskasing Hornepayne Smooth Rock Falls Cochrane Iroquois Falls Timmins Matheson

PORCUPINE HEALTH UNIT Ofﬁce Locations

Timmins (Main Ofﬁce) Cochrane Ottawa Hearst Hornepayne Iroquois Falls Kapuskasing Toronto Matheson Smooth Rock Falls Moosonee

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Table 1. Demographic profile of the Porcupine Health Unit and Ontario

Porcupine Variable Health Unit Ontario Size of Region (km2) a 266, 291 908,608 Population (2011)a 82,165 12,851,821 Population Growth Rate (2006-2011) a,b -1.9% +5.7% Population Density (persons/km2) a 0.3 14.1 Immigrants (%)b 3.2 28.3 Aboriginal Population (%)b 12.3 2.0 Mother tongue (%)a 51.1- English; 69.3- English; 45.9-French; 4.1 - French; 3.0 - Others 26.6 - Others Speaking neither English nor French (%)a 0.1 2.3 Visible Minority (%)b 1.2 22.8 Rural Population (%) b 28.4 14.9 Dependency ratio (%)a 61.1 57.8 Number of Live Births (2012)c 984 136,777

a = Source: Statistics Canada, 2011 Census b = Source: Statistics Canada, 2006 Census c = Source: Ontario Vital Statistics Live Birth Data, Population Estimates, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [May 13, 2013] See the glossary for definitions.

Fig. 2. Population pyramid for the PHU and Ontario

Porcupine Health Unit Ontario

> 85 years > 85 years 80 to 84 years 80 to 84 years 75 to 79 years 75 to 79 years 70 to 74 years 70 to 74 years 65 to 69 years 65 to 69 years 60 to 64 years 60 to 64 years 55 to 59 years 55 to 59 years 50 to 54 years 50 to 54 years 45 to 49 years 45 to 49 years 40 to 44 years 40 to 44 years 35 to 39 years 35 to 39 years 30 to 34 years 30 to 34 years 25 to 29 years 25 to 29 years 20 to 24 years 20 to 24 years 15 to 19 years 15 to 19 years 10 to 14 years 10 to 14 years 5 to 9 years 5 to 9 years 0 to 4 years 0 to 4 years

4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 600 500 400 300 200 100 0 100 200 300 400 500 600 male Population female male Population (000s) female Source: Statistics Canada, 2011 Census

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section 2 SELECTED SOCIAL DETERMINANTS OF HEALTH

Table 2. Selected social determinants of health

Variable PHU % Ontario % Educationa Less than High School 34.4 22.2 High School 23.6 26.8 Apprenticeship or trades certificate or diploma 12.1 8.0 College, CEGEP or other non-university 20.0 18.4 certificate or diploma University certificate or diploma below the 1.9 4.1 bachelor level University certificate, diploma or degree 8.0 20.5 Unemployment rateb 7.4 7.8 Total population under low income cut-offa Both sexes 14.7 12.1 Males 13.7 10.2 Females 15.6 14.0 Children under low income cut-offa Both sexes 17.9 14.8 Males 17.8 14.6 Females 18.0 15.0 Lone parent familiesa 14.6 15.8 Food insecurity (moderate and severe)c 7. 2 7.7 Cost of the Nutritious Food Basket ($)d $197.98 $183.10

a = Source: Statistics Canada, 2006 Census b = Source: Labour Force Survey (special tabulations), Statistics Canada, 2011. Available from: http://www5.statcan.gc.ca/cansim/a26?Lang=eng&retrLang=eng&id=1095324&paS er=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid= c = Source: Statistics Canada, Canadian Community Health Survey (CCHS), 2007/2008. Available from: http://www.statcan.gc.ca/pub/82-221-x/2013001/tblstructure/2nm/2lw/lw2hfi-eng.htm d = Source: Porcupine Health Unit, 2012 See the glossary for definitions.

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The cost of the nutritious food basket in the Porcupine Health Unit area is $14.88 more expensive than the cost of the same basket across the province.

Please note, housing information is not available on a health unit- wide level. However, snapshots of available data are provided here to give a sense of the current picture.

Table 3. Housing information

Variable Local Ontario Homeownership rate a Timmins – 70.3% Cochrane – 76.4% 71.4% Kapuskasing – 66.2% Hearst – 56.2% Average monthly shelter cost for Timmins – $930 households a Cochrane – $778 $1,181 Kapuskasing – $740 Hearst – $778 Percentage of households spending 30% Timmins – 19.1% or more of 2010 total income on shelter Cochrane – 16.7% 27% costs a Kapuskasing – 15.8% Hearst – 21.9% Percentage of households reporting Timmins – 10.5% dwelling in need of major repair a Cochrane – 15.1% 6.6% Kapuskasing – 6.2% Hearst – 11.8% *Number of homeless people in Timmins At risk: 501 in January 2011 b Absolute: 219 Total: 720

a = Source: Statistics Canada, 2011 National Household Survey. Available from: http:// www12.statcan.gc.ca/nhs-enm/2011/as-sa/fogs-spg/?Lang=E b = Source: Kauppi C, Pallard H, Lemieux S, Nkosi TM; Homelessness in Timmins, January 2011 Final Report; Poverty, Homelessness and Migration Centre for Research in Social Justice and Policy, Laurentian University, Sudbury, Ontario; 2012 * = 26% of homeless under age of 9 See the glossary for definitions.

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section 3 MORTALITY

Leading Causes of Death Table 4. Leading causes of death, PHU and Ontario, 2005-09 Cause of death % of all deaths PHU rank Ontario rank Ischaemic heart disease 17.1 1 1 Cancer of the lung and bronchus 8.1 2 2 Chronic lower respiratory diseases 5.2 3 5 Cerebrovascular disease 5.2 4 3 Dementia & Alzheimer Disease 4.1 5 4 Diabetes 3.6 6 7 Cancer of colon, rectum, anus 3.3 7 6 Cancer of lymph, blood & related 2.6 8 8 Intentional self-harm 2.6 9 17 Diseases of urinary system 2.0 10 11 Source: Ontario Mortality Data, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [July 18, 2013].

Unlike the rest of the province, intentional self-harm is among the top ten leading causes of death in the Porcupine Health Unit area.

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Fig. 3. Age-standardized rate per 100,000 for selected causes of death, PHU and Ontario, 2005–07

700

n o

i 600

l u

p 500

0 400

0 0

1 300

e 200

a R 100

0 All Cancers IIsscchemiic HeHeaarrtt RRespirattoorryy UnUniinnttenttionaional l Suicides All Causes Disease Diseases Injuries All Cancers Disease Diseases Injuries Suicides All Causes ■ PHU 189.4 112.7 58.7 33.3 15.0 669.4 ■ Ontario 159.1 86.9 41.3 23.4 7.7 521.8

Source: Statistics Canada, CANSIM Table 102-4309: Mortality and potential years of life lost, by selected causes of death and sex, three-year average, CANSIM database. (accessed: 2013-10-23). See the glossary for definitions.

Note that the Porcupine Health Unit area is statistically significantly higher in all categories, including those that have a preventable component.

Unintentional injuries include transport crashes, falls, poisoning, drowning and fires.

Table 5. Mortality from cancer, PHU and Ontario, 2003-09

Porcupine Health Unit Ontario Age- Age- # of standardized standardized Variables deaths rate/100,000 # of deaths rate/100,000 All cancers* 1,516 201.7 175,798 161.5 Breast 107 26.5 13,355 22.2 Cervical 12 3.0 1,078 2.0 Colorectal* 179 23.2 21,598 19.5 Lung* 437 58.1 43,324 40.6 Prostate 80 25.8 9,561 21.0 Liver 23 3.0 3,169 3.0

Source: Cancer Care Ontario (Ontario Cancer Registry), SEER*Stat Release 9 (November 2012) - OCRIS (May 2012)

* Statistically significantly higher in the Porcupine Health Unit area than the Ontario provincial rate.

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Table 6. Mortality from alcohol-related diseases* (excluding external causes), PHU and Ontario, 2003–09

Porcupine Health Unit Ontario Age- Age- standardized standardized Year Cases rate/100,000 Cases rate/100,000 2003-2009 76 10.6 5,627 5.3

Source: Ontario Mortality Data (Data Years 2003-09), Ontario Ministry of Health and Long- Term Care, IntelliHEALTH ONTARIO, Date Extracted: [October 23, 2013]. * Includes the following ICD-10 codes: F10 (Mental and behavioural disorders due to use of alcohol), G31.2 (Degeneration of nervous system due to alcohol), G62.1 (Alcoholic polyneuropathy), I42.6 (Alcoholic cardiomyopathy), K29.2 (Alcoholic gastritis), K70 (Alcoholic liver disease, including cirrhosis), K85.2 (Alcohol-induced acute pancreatitis), K86.0 (Alcohol- induced chronic pancreatitis).

The list of conditions came from the Canadian Institute for Health Information preventable mortality indicator. These PHU rates are statistically higher than the Ontario ones.

Mortality from alcohol-related diseases for the Porcupine Health Unit area is significantly higher than the rest of the province. This fits with higher than provincial drinking rates in the Porcupine Health Unit area (see section 5 for heavy drinking statistics).

Life Expectancy Table 7. Life expectancy at birth, PHU and Ontario

Porcupine Health Unit Ontario Males (years) 75.2 79.2 Females (years) 80.3 83.6

Source: Statistics Canada. 2013. Health Profile. Statistics Canada Catalogue No. 82-228- XWE. Ottawa. Released April 15, 2013. http://www12.statcan.gc.ca/health-sante/82-228/ index.cfm?Lang=E See the glossary for definitions.

Residents in the Porcupine Health Unit area have a lower life expectancy than in the province as a whole.

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Potentially Avoidable Mortality Table 8. Potentially avoidable mortality from preventable and treatable causes per 100,000 population, PHU and Ontario, 2006-09 (combined)

Porcupine Health Unit Ontario

Both sexes Both sexes combined Male Female combined Male Female Potentially avoidable 279.3 355.7 202.6 172.9 218.0 130.6 mortality Avoidable mortality from preventable 177.6 239.9 115.0 107.7 146.0 71.5 causes Avoidable mortality 101.7 115.8 87.6 65.2 71.9 59.0 from treatable causes

Source: Statistics Canada, Canadian Vital Statistics, Death Database and Demography Division (population estimates), 2006/2008. CANSIM table no.: 102-4311. See the glossary for definitions.

As noted above, the Porcupine Health Unit potentially avoidable mortality rates are statistically significantly higher than the provincial rates.

Injury-Related Mortality Table 9. Mortality due to intentional self-harm, PHU and Ontario, crude rates per 100,000 population by age group, 2005-09 (combined)

Both sexes combined Females Males Age group PHU ON PHU ON PHU ON 0 to 4 0.0 0.0 0.0 0.0 0.0 0.0 5 to 9 0.0 0.0 0.0 0.0 0.0 0.0 10 to 19 54.7 3.3 60.2 2.5 49.4 4.1 20 to 44 32.4 9.8 15.4 4.7 48.9 14.9 45 to 64 14.0 12.5 3.2 6.3 24.1 18.8 65 to 79 20.1 9.1 0.0 4.1 42.5 14.8 80+ 7.0 9.8 0.0 3.4 19.4 21.1 All ages 24.6 8.5 14.4 4.2 34.7 12.9