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Part1 Gendiff.Qxp Sex Differences in Health Status, Health Care Use, and Quality of Care: A Population-Based Analysis for Manitoba’s Regional Health Authorities November 2005 Manitoba Centre for Health Policy Department of Community Health Sciences Faculty of Medicine, University of Manitoba Randy Fransoo, MSc Patricia Martens, PhD The Need to KnowTeam (funded through CIHR) Elaine Burland, MSc Heather Prior, MSc Charles Burchill, MSc Dan Chateau, PhD Randy Walld, BSc, BComm (Hons) This report is produced and published by the Manitoba Centre for Health Policy (MCHP). It is also available in PDF format on our website at http://www.umanitoba.ca/centres/mchp/reports.htm Information concerning this report or any other report produced by MCHP can be obtained by contacting: Manitoba Centre for Health Policy Dept. of Community Health Sciences Faculty of Medicine, University of Manitoba 4th Floor, Room 408 727 McDermot Avenue Winnipeg, Manitoba, Canada R3E 3P5 Email: [email protected] Order line: (204) 789 3805 Reception: (204) 789 3819 Fax: (204) 789 3910 How to cite this report: Fransoo R, Martens P, The Need To Know Team (funded through CIHR), Burland E, Prior H, Burchill C, Chateau D, Walld R. Sex Differences in Health Status, Health Care Use and Quality of Care: A Population-Based Analysis for Manitoba’s Regional Health Authorities. Winnipeg, Manitoba Centre for Health Policy, November 2005. Legal Deposit: Manitoba Legislative Library National Library of Canada ISBN 1-896489-20-6 ©Manitoba Health This report may be reproduced, in whole or in part, provided the source is cited. 1st Printing 10/27/2005 THE MANITOBA CENTRE FOR HEALTH POLICY The Manitoba Centre for Health Policy (MCHP) is located within the Department of Community Health Sciences, Faculty of Medicine, University of Manitoba. The mission of MCHP is to provide accurate and timely information to health care decision-makers, analysts and providers, so they can offer services which are effective and efficient in maintaining and improving the health of Manitobans. Our researchers rely upon the unique Population Health Research Data Repository to describe and explain pat- terns of care and profiles of illness, and to explore other factors that influ- ence health, including income, education, employment and social status. This Repository is unique in terms of its comprehensiveness, degree of inte- gration, and orientation around an anonymized population registry. Members of MCHP consult extensively with government officials, health care administrators, and clinicians to develop a research agenda that is topi- cal and relevant. This strength along with its rigorous academic standards enable MCHP to contribute to the health policy process. MCHP under- takes several major research projects, such as this one, every year under con- tract to Manitoba Health. In addition, our researchers secure external fund- ing by competing for other research grants. We are widely published and internationally recognized. Further, our researchers collaborate with a num- ber of highly respected scientists from Canada, the United States and Europe. We thank the University of Manitoba, Faculty of Medicine, Health Research Ethics Board for their review of this project. The Manitoba Centre for Health Policy complies with all legislative acts and regulations governing the protection and use of sensitive information. We implement strict policies and procedures to protect the privacy and security of anonymized data used to produce this report and we keep the provincial Health Information Privacy Committee informed of all work undertaken for Manitoba Health. i ii ACKNOWLEDGEMENTS This report was possible only through a true Team effort, including The Need To Know Team members, MCHP staff and researchers, Manitoba Health, Canadian Institutes of Health Research (CIHR), our special Working Group of men’s and women’s health experts, and many other indi- viduals and organizations who made contributions to this project: ● The Working Group, who worked alongside The Need To Know Team, providing clinical guidance and research expertise: (alphabetically) Lissa Donner, Margaret Haworth-Brockman, Dr. Patricia Kaufert, Dr. Frank Martin, Peri Venkatesh, and from Manitoba Health: Dale Brownlee and Kathie Love. ● Individual members of The Need To Know Team since its inception in the spring of 2001 up to August 2005: The RHA representatives, both past and present, including: Jody Allen, Val Austen-Wiebe, Jim Bentley, Dr. Shelley Buchan, Mieke Busman, Maggie Campbell, Cynthia Carr, Maria Cendou, Donna Champagne, Connie Chapen, Dr. Eilish Cleary, Sue Crockett, Bev Cumming, Susan Derk, Dr. Albert De Villiers, Suzanne Dick, Marion Ellis, Tannis Erickson, Margaret Fern, Doreen Fey, Pattie Fries, Bonnie Frith, Dr. Randy Gesell, Catherine Hynes, Betty MacKenzie, Nancy McPherson, Debbie Nelson, Carmel Olson, Dr. Jan Roberts, Pam Seitz, Steve Todd, Dr. Jan Trumble Waddell, Faye White. The Manitoba Health representatives, both past and present, including: Valdine Berry, Lorraine Dacombe Dewar, Shirley Dzogan, Dr. Bob Li, Rachel McPherson, Dr. Shahin Shoostari, Heather Sparling, Deborah Malazdrewicz. The MCHP staff members who contribute to the ongoing support and planning of Team meetings, including Darlene Harder, Kristin Backhouse, Linda Kostiuk, and Carole Ouelette. The The Need To Know project has benefitted from an ongoing evalua- tion led by Dr. Sarah Bowen, and recently assisted by Jen Magoon. ● The RHA CEOs for their ongoing support of this collaborative research project. iii ● MCHP personnel and others who helped us immensely in the review- ing, editing and production of this report, as well as in the provision of advice on analyses: Jo-Anne Baribeau, Dr. Marni Brownell, Dr. Patricia Caetano, RJ Currie, Jeremy Dacombe, Matt Dahl, Dr. Carolyn De Coster, Shelley Derksen, Oke Ekuma, Janine Harasymchuk, Dr. Alan Katz, Dr. Anita Kozyrskyj, Dr. Lisa Lix, Leonard MacWilliam, Rod McRae, Dr. Verena Menec, Dr. Colleen Metge, Patrick Nicol, Dr. Les Roos, and Marina Yogendran. ● Personnel from Manitoba Health (in addition to those on the NTK team) who provided detailed assistance on data issues: Cecile Simard, Linda Ladobruk, and Tara Mawhinney. ● Dr. Bruce Martin, Director of the J.A. Hildes Northern Medical Unit, who assisted in interpretation of pharmaceutical data in northern areas, and physician services in Churchill. The authors are indebted to Health Information Services of Manitoba Health, and the Office of Vital Statistics in the Agency of Consumer and Corporate Affairs, for the provision of data. We acknowledge the Canadian Institutes of Health Research (Community Alliances for Health Research program) for co-funding The Need To Know Team’s five-year collaboration (2001–2006). We acknowledge the Faculty of Medicine Health Research Ethics Board for their thoughtful review of this project. The Health Information Privacy Committee of Manitoba Health is kept informed of all MCHP deliverables for Manitoba Health. Strict policies and procedures to protect the privacy and security of data have been followed in producing this report. We also acknowledge the financial support of the Department of Health of the Province of Manitoba. The results and conclusions are those of the authors and no official endorsement by Manitoba Health was intended or should be inferred. This report was prepared at the request of Manitoba Health as part of the contract between the University of Manitoba and Manitoba Health. iv TABLE OF CONTENTS EXECUTIVE SUMMARY . .xxv CHAPTER 1: INTRODUCTION AND METHODS . .1 1.1 The Collaborative Network for This Report . .1 1.2 The Geographical Boundaries in This Report . .2 1.3 What’s in This Report? . .7 1.4 The Indicators—Key Concepts . .7 1.5 The Graphs—Which Comparisons and What Order? . .9 1.6 Data Sources and Years of Data Used . .12 1.7 Rates and Prevalence, Standardization, and Statistical Anaylses . .13 1.8 Difference Between a ‘Rate’ and Prevalence’ . .15 1.9 Difference in Methodology . .16 1.10 Summary . .16 References . .18 CHAPTER 2: HEALTH STATUS AND MORTALITY . .19 2.1 Life Expectancy . .22 2.2 Total Mortality Rates . .26 2.3 Mortality Rates by Sex and Cause . .30 2.4 Premature Mortality Rates (PMR) . .36 2.5 Potential Years of Life Lost (PYLL) . .40 References . .44 CHAPTER 3: DISEASE TREATMENT PREVALENCE AND INCIDENCE . .45 3.1 Hypertension Treatment Prevalence . .48 3.2 Arthritis Treatment Prevalence . .52 3.3 Total Respiratory Morbidity (TRM)Treatment Prevalence . .56 3.4 Diabetes Treatment Prevalence . .60 3.5 Ischemic Heart Disease Treatment Prevalence . .64 3.6 Infertility Treatment Prevalence . .68 3.7 Renal Failure Treatment Prevalence . .72 3.8 Inflammatory Bowel Disease (IBD)Treatment Prevalence (Crohn’s and Colitis) . .76 3.9 Acute Myocardial Infarction (AMI) Incidence Rates (Hospitalization or Death) . .80 3.10 Stroke Incidence Rates (Hospitalization or Death) . .84 3.11 Hip Fracture Incidence Rate . .88 3.12 Lower Limb Amputation Due to Diabetes . .92 References . .96 v CHAPTER 4: PHYSICIAN SERVICES . .99 4.1 Use of Physicians . .102 4.2 Ambulatory Visit Rates . .106 4.3 Ambulatory Consultation Rates . .110 4.4 Ambulatory Visit Rates to Specilists . .114 4.5 Complete Physical Exams . .118 4.6 Continuity of Care . .122 4.7 Physician Visit Rates by Cause . .126 4.8 Visit Rates by Physician Specialty . .134 References . .141 CHAPTER 5: HOSPITAL SERVICES . .143 5.1 Total Separation Rates . .146 5.2 Separation Rates for Short Stays (0 to 29 Days) . .150 5.3 Separation Rates for Short Stays by Cause . .154 5.4 Separation Rates for Long Stays (30+ Days) . .162 5.5 Separation Rates for Long Stays (30+ Days) by Cause . .166 5.6 Separation Rates for Inpatient Care . .168 5.7 Separation Rates for Day Surgery . .172 5.8 Total Hospital Days Used . .176 5.9 Hospital Days Used for Short Stays (1 to 29 Days) . .180 5.10 Hospital Days Used in Short Stays (0 to 29 Days) by Cause . .184 5.11 Hospital Days Used for Long Stays (30+ Days) . .190 5.12 Hospital Days Used in Long Stays (30+ Days) by Cause . .194 References . .200 CHAPTER 6: SURGICAL AND DIAGNOSTIC PROCEDURES .
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