Writing & Development Team
Andreas Wielgosz, MSc, MD, PhD, Chair, Monitoring, Surveillance & Evaluation Expert Panel, Champlain Cardiovascular Disease Prevention Network Jim Jaffey MSc, Epidemiology Consultant Kathryn Williams, Research Biostatistician, Children’s Hospital of Eastern Ontario Research Institute Sophia Papadakis, BSc, MHA, PhD, Program Leader, Champlain Cardiovascular Disease Prevention Network Danielle Simpson, Analyst, Champlain Cardiovascular Disease Prevention Network Laurie Dojeiji, BSc, Coordinator, Champlain Cardiovascular Disease Prevention Network
Contributors
Bruce Libman, PhD, Epidemiology and Decision Support Consultant, Champlain Local Health Integration Network
Correspondence
Champlain CVD Prevention Network c/o Heart Health Education Centre, H-2353 University of Ottawa Heart Institute 40 Ruskin Street, Ottawa, ON K1Y 4W7
www.ccpnetwork.ca
May 2011
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Champlain Cardiovascular Disease Prevention Network (CCPN) Monitoring, Surveillance & Evaluation Expert Panel
Dr. Andreas Wielgosz Chair, CCPN Monitoring, Surveillance & Evaluation Expert Panel
Amira Ali Senior Epidemiologist, Surveillance, Emerging Issues, Education & Research Division (SSER), Ottawa Public Health Dr. Rachel Colley Junior Research Chair, Healthy Active Living and Obesity (HALO) Research Group, CHEO John Cunningham Epidemiologist, Leeds, Grenville & Lanark District Health Unit Bruce Libman Epidemiologist and Decision Support Consultant, Champlain Local Health Integration Network Peggy Patterson Coordinator, Program Planning and Evaluation, Renfrew County and District Health Unit Brian Schnarch Senior Epidemiology and Decision Support Consultant, Champlain Local Health Integration Network Dr. Gamil Shahein Epidemiologist, Eastern Ontario Health Unit
Dr. Michael Sharma Director, Champlain Regional Stroke Centre, The Ottawa Hospital
Dr. George Wells Director, Cardiovascular Research Methods Centre, University of Ottawa Heart Institute Dr. Kathryn Wilkins Senior Analyst, Health Statistics Division, Statistics Canada
Kathryn Williams Research Biostatistician, CHEO Research Institute, Adjunct Professor, Department of Epidemiology and Community Medicine Sophia Papadakis CCPN Program Leader
Danielle Simpson CCPN Analyst
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CHAMPLAIN CARDIOVASCULAR DISEASE PREVENTION NETWORK
The Champlain Cardiovascular Disease Prevention Network (CCPN) is a strategically aligned network of health and community partners which include public health, specialty (cardiac and stroke) care, primary care, hospitals, community health, and academia. The Network was formed in 2005 to provide leadership to the implementation of the Champlain Cardiovascular Disease (CVD) Prevention Strategy. The overarching goal of the CCPN is to build a system of excellence in integrated CVD prevention and management to ensure that the citizens of the Champlain Region are the most heart healthy and stroke-free in Canada. This will be accomplished through the implementation of large-scale, community-based initiatives recommended by the CCPN Expert Panels and endorsed by the CCPN Coordinating Committee as the most important actions to improve the CVD health of Champlain residents in six key areas: primary care, specialty care, hospitals, schools, workplaces, and communities. The approach is community-based, coordinated, action-focused and outcome-oriented.
CCPN Partners Champlain Local Health Integration Network Champlain Regional Stroke Centre City of Ottawa Public Health Unit Department of Family Medicine, University of Ottawa Eastern Ontario Community Primary Health Care Network Eastern Ontario Health Unit Élisabeth Bruyère Research Institute Healthy Active Living & Obesity Research Group, CHEO Heart and Stroke Foundation of Ontario Institute of Population Health, University of Ottawa Leeds, Grenville & Lanark District Health Unit Ottawa Public Health Renfrew County & District Health Unit The Ottawa Hospital University of Ottawa Heart Institute
CCPN Founding Industry Partner Pfizer Canada Inc.
The Champlain Cardiovascular Disease Prevention Network (CCPN) was catalyzed by the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute (UOHI), recognizing the need for a coordinated, strategic, regional approach to successfully address the burden of cardiovascular disease (CVD) in the Champlain Region. The CCPN Project Management Team is housed at the UOHI.
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FOREWORD The Atlas of Cardiovascular Health in the Champlain Region 2011, differs from the previous edition from 2008 primarily in that it includes the results of a population survey conducted in the second half of 2009. A random sample of the adult population of the Champlain Region was invited to answer several questionnaires, undergo physical measurements such as blood pressure, height and weight and provide samples of blood and urine. The survey was also carried out in collaboration with 3 other centers across Canada, in Vancouver, Hamilton and Laval, all of which took part in the international Prospective Urban Rural Epidemiologic (PURE) study. While analyses of the data will keep us busy for some time to come, the initial reports of risk factor prevalence rates are presented in this document. Such baseline data will allow us to determine whether we are making progress in improving the heart health of the people of Champlain Region as a result of the various activities undertaken by the CCPN. Furthermore, the data can help target interventions where prevalence rates are particularly high and with additional information about key socioeconomic factors, more refined interventions can be developed. This means of course, that the survey will have to be repeated in the future. While many individuals were involved with the survey, a special acknowledgement and a big thank you is owed to Ms. Stella Muthuri, who masterfully inspired and led her team to complete the survey. We are also grateful to the citizens of Champlain who willingly contributed their time to participate.
Although the data presented in this Atlas relate to adults aged 18 and up, it is well known that unhealthy lifestyle habits begin at a young age in the home and at school. What we see in adults tends to be a continuation of those habits, sometimes in worse form. What we measure are the consequences of those unhealthy lifestyle choices, which collectively constitute the burden of cardiovascular diseases. Indicators of those lifestyle habits as well as early signs of the consequences are the risk factors. Over two-thirds of cardiovascular disease is explained by modifiable risk factors. Changing individual risk factors at the same time trying to reverse the early onset of disease is a daunting task and one in which we see slow progress. To achieve widespread success requires a change in the environmental conditions, which presently support unhealthy lifestyles. Opportunities for physical activities, accessible heart healthy foods and protection of smoke-free environments are some examples of the favourable conditions that communities must strive for. Such conditions are also important factors that need to be measured and studied so as to guide policies with appropriate resources to support them. In this edition of the Atlas we begin to examine a few of these environmental factors. In the future, there will be more data and more scrutiny, which hopefully will spur appropriate interventions.
As with the previous edition, the CCPN and its stakeholders are committed to the widest possible dissemination of this Atlas. We hope that this publication will be useful as a resource informing policies and programs for a better heart health in the Champlain Region. Finally, we invite readers to provide us feedback, identifying additional gaps and needs as we forge ahead with a variety of programs and ongoing epidemiologic research.
Andreas Wielgosz, MSc, MD, PhD Chair, Monitoring, Surveillance & Evaluation Expert Panel Champlain CVD Prevention Network
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EXECUTIVE SUMMARY
The Atlas of Cardiovascular Health in the Champlain Region, 2011 is the fourth edition of earlier documents profiling the heart health of Champlain residents. These earlier publications brought to attention the regional disparities in CVD and risk factors observed within the Champlain Region, and served to support the planning activities underlying the development of the regional CVD Prevention Strategy being led by the CCPN. Specifically, three regions within Champlain – Renfrew, Eastern Ontario (in particular Prescott & Russell), and Leeds, Grenville & Lanark – were identified as Ontario “hot spots” for CVD morbidity and mortality, with rates significantly higher than those reported for the City of Ottawa, the province of Ontario, and Canada, as shown in the summary table below. In an effort to close these regional gaps in cardiovascular health, the CCPN launched its five-year CVD Prevention Strategy which includes six major initiatives designed to address the prevention and management of the leading modifiable risk factors for heart disease and stroke. These include: smoking, physical inactivity, unhealthy eating habits, obesity/ overweight, diabetes/ blood glucose, abnormal blood cholesterol, and high blood pressure.
The 2011 Atlas is an update of the 2008 edition, and both are a product of an extensive and thorough examination of CVD, risk factors, and determinants of cardiovascular health in the Champlain Region, chronicled in a systematic fashion for the four public health units. In all chapters, an attempt has been made to provide the most up to date data available to us. It begins with a regional, health unit-by-health unit profile of the population of the Champlain Region (Chapter 1), then moves to systematically dissect the regional variations in CVD mortality and morbidity (Chapter 2), and continues with an examination of the prevalence of the major cardiovascular risk factors (Chapter 3) with breakdown by socio-economic status (Chapter 4). While CVD remains the primary focus of the Atlas, an effort was taken to include a wider scope and cover other related conditions, such as diabetes, as well as to extend the presentation of risk factors to include some of the socio- demographic characteristics within the region. Chapters 1 to 4 begin with an introductory overview and continue with a presentation of regional data, broken down where possible, by district health unit, and with provincial and national-level data provided as comparators. The final chapter of the Atlas (Chapter 5) includes a discussion of the current surveillance gaps and future directions, and describes the baseline data of a new regional initiative led by the CCPN – the Champlain Community Heart Health Survey (CCHHS) – designed to address some of the gaps, for example lack of physical measures, by collecting key information relevant to the heart health of the residents of the Champlain Region. Baseline data for the CCHHS was collected during 2008-2009 and is presented in Chapter 5. A summary of data sources and data notes, as well as a glossary of terms, are included in the Appendix.
Based on the currently available data, most of the population in the Champlain Region, particularly outside of the City of Ottawa, is not at an optimal low level of risk. Since decreasing cardiovascular risk factors in the population can have a great impact on reducing the disease and economic burdens of CVD, it follows that efforts should be directed towards promoting a population-wide strategy to prevent, and not just restrain at best, “the most preventable of major epidemics”.1The challenge is to implement a population approach to prevention while lacking the necessary data identifying populations at greatest risk for CVD and in greatest need of prevention efforts. In the absence of a robust surveillance system, currently existing health and non-health status data are incomplete and fragmented.
This Atlas emphasizes the importance of measurement to health outcome improvements and is intended to stimulate better data-gathering and regular monitoring of the temporal and geographic distribution and trends in disease and risk factor rates. Furthermore, with regional efforts, such as the Champlain Community Heart Health Survey, meaningful benchmarks have been established to measure progress and guide the future planning, priority setting, and evaluation of primary and secondary prevention efforts by health care providers and organizations within the Champlain Region.
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Self-reported prevalence of risk factors in persons aged 12 years and older in Canada, Ontario, and Champlain Region and its Health Regions, 2009.
* * Daily Physical < 5 servings Hypertension Diabetes Overweight Obesity REGION Smoking Inactivity fruit & veg/day n (%) n (%) n (%) n (%) n (%) n (%) n (%)**
5,395,232 2,023,212 11,363,707 6,035,915 5,260,351 16,017,095 15,376,411 Canada (16.9%) (6.0%) (33.7%) (17.9%) (15.6%) (47.5%) (45.6%)
2,247,162 836,153 4,442,066 2,273,292 1,881,345 6,440,995 5,761,620 Ontario (17.2%) (6.4%) (34.0%) (17.4%) (14.4%) (49.3%) (44.1%)
183,409 75,087 411,133 220,337 157,560 512,070 562,538 Champlain (14.9%) (6.1%) (33.4%) (17.9%) (12.8%) (41.6%) (45.7%)
City of 127,072 48,536 277,980 137,666 82,952 350,343 423,588 Ottawa (14.4%) (5.5%) (31.5%) (15.6%) (9.4%) (39.7%) (48.0%)
Eastern 27,868 16,920 76,624 51,158 41,205 97,938 88,582 Counties (14.0%) (8.5%) (40.0%) (25.7%) (20.7%) (49.2%) (44.5%)
Renfrew 18,761 7,200 39,651 22,310 22,716 44,620 32,755 County (18.5%) (7.1%) (39.1%) (22.0%) (22.4%) (44.0%) (32.3%)
Leeds, 8,877 2,975 17,803 10,845 10,125 20,251 18,043 Grenville (18.5%) (6.2%) (37.1%) (22.6%) (21.1%) (42.2%) (37.6%) & Lanark
*Prevalence based on the population aged 18 and over. ** Prevalence based on the population aged 12 and over.
Source: For Canada and Ontario population estimates, Statistics Canada, CANSIM, table 051-0001. For Champlain, Ottawa, Eastern Counties, Renfrew County and Leeds, Grenville & Lanark population estimates, Ontario Ministry of Health and Long-Term Care, intelliHEALTH Ontario, Date Extracted: March 2011 For Champlain, Ottawa, Eastern Counties, Renfrew County and Leeds, Grenville & Lanark risk factor data, Statistics Canada. Canadian Community Health Survey, 2009. .
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TABLE OF CONTENTS
CHAMPLAIN CARDIOVASCULAR DISEASE PREVENTION NETWORK……………...….…… 4
FOREWORD…………….……………………………………………………………………….……… 5
EXECUTIVE SUMMARY………………………………………………………………………………. 6
TABLE OF CONTENTS……………………………………………………………………….……….. 8
LIST OF FIGURES……………………………………………………………………………………… 10
LIST OF TABLES…………………………..……………………………………………………..……… 12
INTRODUCTION…………………………………...…………………………………………..………… 15
CHAPTER 1………………………………...………………………………………………….………. 16
THE CHAMPLAIN REGION AND ITS PEOPLE………………………………………… 16
Champlain Region Overview………………………………………...... ………….. 16 Demographic and Social Profile…………………………………………………… 18 Language…………………………………………………………………………….. 20 Mother Tongue………………………………………………………………. 20 Language Spoken Most Often at Home…………………………………… 20 Other Languages………………………..………………………………….. 20 Francophones in the Champlain Region…………………………...... ………….. 21 Ethnicity………………………………………………………………...... 21 Aboriginal Persons……………………………………………………...... 22 Income and Employment………………..……………………………...…………. 24 Education…………………………………………..…………………...... 24 Socio-economic Status……………………………………………………………... 25 Health Status…………………………………………………………...... 25 Overall Self-rated Health…………………………………………………... 25 Access to a Family Physician……………………………………………... 25
CHAPTER 2……………………………………...……………………………………………..…….. 27
BURDEN OF CARDIOVASCULAR DISEASE……..……………………………………… 27
Prevalence.………………………………...…………………………...... 27
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Mortality.…………………………………...…………………………...... 29 Potential Years of Life Lost (PYLL).…………………….………...... 37 Hospitalizations...…………………………………………….……...... 38 Emergency Department Visits and General Practitioner/Family Practitioner Visits ...……………………..………………………………….……...... 44
CHAPTER 3……………………………………...……………………………………………..………. 46
RISK FACTORS FOR CARDIOVASCULAR DISEASE……………………………………. 46
High Blood Pressure………………..………………………………………………… 46 Tobacco Smoking………………..……………………………………………………. 48 Smoking Status………..………………………………………………………. 48 Age at Initiation of Smoking....………………………………………………. 49 Exposure to Second-hand Smoke in Past Month in Public Places……… 50 Diabetes………………………………………………………………………………… 51 Overweight & Obesity…………………………………………………………………. 53 Physical Inactivity………………..………………………………...…...... 55 Adequate Consumption of Fruit & Vegetables…………………………………….. 57
CHAPTER 4……………………………………...…………………………………..…………………… 58
RISK FACTORS BY SOCIO-ECONOMIC STATUS………………………………....…….. 58
Household Income……………………………………………………………………... 58 Education………………………………………………………………………………… 58
CHAPTER 5……………………………………………………………………………………………….. 61
SURVEILLANCE GAPS & FUTURE DIRECTIONS…………………………….…………… 61
The Champlain Community Heart Health Survey (CCHHS).…………………….. 62
Data Analysis ………………………………………………………………………….. 62
CCHHS Results ……………………………………………………………………….. 63
Future Directions……………………………………………………………………….. 69
REFERENCES…………………………………………………….………………………………………. 71
APPENDICES…………………………………………………….………………………………………. 72
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DATA SOURCES…………………………………………………………………………….… 73 GLOSSARY OF TERMS……………………………………………………………………… 75
LIST OF FIGURES
CHAPTER 1………………………………...………………………………………………….……….. 16
Figure 1.1: Champlain LHIN of Ontario………………………………………………………. 16
Figure 1.2: Champlain Region, age characteristics, both sexes, 2009………..………..... 18
Figure 1.3: Champlain Region, age characteristics, by age group and sex, 2009……… 19
Figure 1.4: Language spoken most often at home, Champlain Region, 2006…………. 20
Figure 1.5: Number of Aboriginal persons, by sex, for Ottawa, Prescott & Russell, Renfrew County, and Leeds, Grenville & Lanark, 2006………………………. 22
Figure 1.6: Number of Aboriginal persons in Champlain Region, by age group, both sexes, 2006………………………………………………………………….. 23
Figure 1.7: Percentage of the Aboriginal identities within the Champlain Region, 2006.. 23
Figure 1.8: Index of relative socio-economic disadvantage in the Champlain Region..… 26
CHAPTER 2……………………………………...……………………………………………..……….. 27
Figure 2.1: Percent of population by age group and geography that has self-identified as having a history of stroke, 2009.……………………………………….….... 28
Figure 2.2: Percent of population by age group and geography that has self-identified as having heart disease, 2009………………………..…...... 28
Figure 2.3: Percentage of total deaths due to circulatory diseases, cancer and other causes, Champlain Region, 2005………………………………………...... 29
Figure 2.4: Percentage of total deaths due to circulatory diseases, cancer and other causes, Champlain Region and Ontario, 2005……………………………….… 30
Figure 2.5: Age-standardized mortality rates (per 100,000 population) for acute myocardial infarction, 2002-2005……………………………………….………… 31
Figure 2.6: Age-standardized mortality rates (per 100,000 population) for ischemic heart disease, 2002-2005………………………………………..………………… 31
Figure 2.7: Age-standardized mortality rates (per 100,000 population) for heart failure, 2002-2005………………………………………………………….………. 32
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Figure 2.8: Age-standardized mortality rates (per 100,000 population) for cerebrovascular disease, 2002-2005…………………………………………… 32
Figure 2.9: Age-standardized mortality rates (per 100,000 population) for diabetes, 2002-2005………………………………………………………….…...…………….. 33
Figure 2.10: Percentage of total hospitalizations due to cardiovascular diseases, Champlain Region and Ontario, 2006.…………………………………………… 39
Figure 2.11: Age-standardized hospitalization rates (per 100,000 population) for acute myocardial infarction, 2006-2009………………………..…..……………. 39
Figure 2.12: Age-standardized hospitalization rates (per 100,000 population) for ischemic heart disease, 2006-2009………………..………………….…………. 40
Figure 2.13: Age-standardized hospitalization rates (per 100,000 population) for heart failure, 2006-2009…………….……………………………………….……. 40
Figure 2.14: Age-standardized hospitalization rates (per 100,000 population) for cerebrovascular disease, 2006-2009…………………..……………………….. 41
Figure 2.15: Age-standardized hospitalization rates (per 100,000 population) for diabetes, 2006-2009…………..……………………………………..…………….. 41
CHAPTER 3……………………………………...………………………………………………..……... 46
Figure 3.1: Percentage (95% CI) of general population who reported having been diagnosed by a health professional as having high blood pressure, by age group, 2009 ………………………………………………………………………. 47
Figure 3.2: Percentage (95% CI) of general population who reported having been diagnosed by a health professional as having diabetes, by age group, Champlain Region and Health Units, 2009…………………………………….. 52
Figure 3.3: Percentage of general population in the Champlain Region whose BMI based on self-reported information indicated overweight and obese, by age group, 2009………………………………………………………………...……. 55
Figure 3.4: Percentage (95% CI) of general population in the Champlain Region who reported being physically inactive, by age group, 2009……………………….. 56
CHAPTER 4……………………………………...…………………………………………..………….. 58
Figure 4.1: Percentage of Champlain population aged 12 and over with self-reported cardiovascular risk factors, by household income group, 2008……………….. 59
Figure 4.2: Percentage of Champlain population aged 12 and over with self-reported cardiovascular risk factors, by household income group, 2008………………. 60
CHAPTER 5……………………………………...…………………………………………..………….. 61
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Figure 5.1: Percentage Risk of Females Developing a Heart Attack or Coronary Death Over the Next 10 Years in Select Ottawa Populations ……………………… 69
Figure 5.2: Percentage Risk of Males Developing a Heart Attack or Coronary Death Over the next 10 Years in Select Ottawa Populations ……………………………… 70
LIST OF TABLES
EXECUTIVE SUMMARY..………..…………...………………………………………………………… 6
Cardiovascular Disease mortality numbers and rates per 100,000 population and self-reported prevalence of risk factors in persons aged 12 years and older in Canada, Ontario, and Champlain Region and its Health Regions, 2009 7
CHAPTER 1………………………………...……………………………………………..……………… 16
Table 1.1: Champlain Region population, 2001 and 2009….…………………………….. 17
Table 1.2: Age characteristics, by Champlain Region Health Units, 2009…………………. 19
Table 1.3: Distribution of Francophones in Champlain Region, 2006…………………….. 21
Table 1.4: Educational attainment and unemployment status for Aboriginal persons in Ottawa, Prescott & Russell, Renfrew County, and Leeds, Grenville & Lanark, 2006…………………………………………………………………..… 26
Table 1.5: Adult and youth unemployment rate in Ontario, Champlain and its Region Health Units, 2005 and 2009………..…………………………….……. 25
CHAPTER 2……………………………………...………………………………………………………. 27
Table 2.1: Age- and sex-specific mortality rates (per 100,000 population), Champlain Region, 2002-2005………………………………………………………………….. 34
Table 2.2: Age-standardized mortality rates (per 100,000 population), City of Ottawa, Eastern Counties, and Renfrew County, 2004-2007……….…………………… 36
Table 2.3: Age- and sex-standardized PYLL rates per 100,000 population (avg. 2003- 2005), Champlain Region and Ontario……….………………………………….. 38
Table 2.4: Age- and sex-specific hospitalization rates (per 100,000 population), Champlain Region, 2006-2009………….….…………………………………….. 42
Table 2.5: Age-standardized hospitalization rates (per 100,000 population) for City of Ottawa, Eastern Counties, and Renfrew County, 2006-2009………………… 43
Table 2.6: Emergency department visit and GP/FP visit rates by age group and sex, per 100,000 population, Champlain Region and Ontario, 2008…………….. 45
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CHAPTER 3……………………………………...………………………………………………..……… 46
Table 3.1: Percentage (95% CI) of general population aged 12 and over who reported having been diagnosed by a health professional as having high blood pressure, by sex, 2003 and 2009 …………………….…………………………………….. 47
Table 3.2: Percentage (95% CI) of general population aged 12 and over who reported being a current smoker (daily or occasional), by sex, 2003 and 2009.…….. 48
Table 3.3: Percentage (95% CI) of general population aged 12 and over who reported being a current smoker, by sex, 2003 and 2009…………….………………… 49
Table 3.4: Percentage (95% CI) of general population who reported initiating smoking between the age of 5 to 14 years, by sex, 2003 and 2008…..………………. 50
Table 3.5: Percentage (95% CI) of general population who reported exposure to second-hand smoke in the past month, in vehicles and/ or public places, by sex, 2003 and 2009…………………………………………………….……… 51
Table 3.6: Percentage (95% CI) of general population aged 12 and over who reported having been diagnosed by a health professional as having diabetes, by sex, 2003 and 2009 …………………………………………………………………….. 52
Table 3.7: Percentage (95% CI) of general population aged 18 and over whose BMI based on self-reported information indicated overweight (25.00 to 29.99), by sex, Canada, Ontario, Champlain Region, and Health Unit, 2003 and 2009…...... 53
Table 3.8: Percentage (95% CI) of general population aged 18 and over whose BMI based on self-reported information indicated obese (30.00 or higher), by sex, 2003 and 2009 ..…………………………………………….…...... 54 . Table 3.9: Percentage (95% CI) of Champlain Region youth aged 12 to 17 whose BMI based on self-reported information indicated overweight or obese, 2007 and 2009……………………………………………………………………...... 54
Table 3.10: Percentage (95% CI) of general population aged 12 and over who reported being physically inactive, 2003 and 2009….………………………………….. 56
Table 3.11: Percentage (95% CI) of general population aged 12 and over who reported consuming less than 5 servings of fruit and vegetables per day, by sex, 2003 and 2009………………………………………………………………………….. 57
Chapter 5
Table 5.1: Marital Status by Gender and Urban Rural Residence.………………………… 63
Table 5.2: Champlain population by Ethnicity for Gender and Urban Rural categories … 63
Table 5.3: Champlain population by Education for Gender and Urban Rural categories.. 64
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Table 5.4: Medical History & Diagnosis ……………………….……………………………… 64
Table 5.5 Years Since Diagnosis …………………….……………………………………….. 65
Table 5.6: Medications …………………………………………………………………………... 65
Table 5.7: Tobacco Use ………………………………………………………………………… 66
Table 5.8: Age Started Smoking ……………………………………………………………… 66
Table 5.9: Smoking History ……………………………………………………………………. 67
Table 5.10: Exposure to Secondhand Smoke ………………………………………………. 67
Table 5.11: Physical Measures ………………………………………………………………. 68
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INTRODUCTION How heart healthy are the residents of the Champlain Region? To answer this question, the Atlas of Cardiovascular Health in the Champlain Region, 2011 was produced as part of an ongoing assessment of the heart health of the population in the region. The geographic area of the Champlain Region encompasses a significant portion of Eastern Ontario, home to almost 1.2 million residents, with a rich diversity of urban and rural communities, as well as socio-economic, cultural, and linguistic populations. Comprised of four planning areas – City of Ottawa, Eastern Counties of Prescott & Russell and Stormont, Dundas & Glengarry, Renfrew County, and the northern parts of Leeds, Grenville & Lanark County – the Champlain Region faces unique challenges in terms of health, health care planning, and health care provision. This is because these areas vary by not only population size, but also the age structure, social characteristics, and economic conditions.
This Atlas was developed by the CCPN as a local resource meant to inform a diverse group of readers on the state of cardiovascular health in the region. Inspired by several provincial and national atlases and publications of the Institute for Clinical Evaluative Sciences (ICES), the Canadian Cardiovascular Outcomes Research Team (CCORT), and the Heart and Stroke Foundation of Canada (HSFC), this document focuses on mapping and charting the cardiovascular health status on a population-wide basis within the Champlain Region, drawing comparisons across age groups and genders and, where possible, across the four public health units within the boundaries of the Champlain Region.
This publication examines, on a local level, the diverse elements of the epidemiology of CVD. Where possible, the regional variations in CVD mortality and morbidity observed within each public health unit are related to differences in the prevalence of the major cardiovascular risk factors and presented along with the region, provincial, and national averages. The Atlas also demonstrates a methodology that will be able to identify the CVD “hot spots” where Champlain residents are at particularly high risk for cardiac death.
The development of the Atlas was driven by the premise that one strategy to overcome the growing burden of CVD involves providing actionable information relevant for the development and implementation of appropriate policies. The availability of actionable information depends on our ability to measure and monitor the state of CVD and health care. In the absence of a robust surveillance system, these data are not always available or they are limited and fragmented. This is why the CCPN established a Monitoring, Surveillance & Evaluation Expert Panel to overlook the development of systems to monitor trends, risk factors, and behaviours in our region needed to support research, health planning, case finding and patient management, as well as to develop infrastructure, teams, and methodologies to support high quality evaluation of CVD prevention activities. This Atlas represents a significant early product of this Panel’s work and aims to accomplish several objectives:
to present the best available data and identify gaps in knowledge on the state of cardiovascular health across the Champlain Region, including prevalence of disease, risk factors, and associated health outcomes; to identify and bring to attention important geographic and other disparities in cardiovascular health within the Champlain Region; and, to demonstrate the value and importance of surveillance activities and encourage better data-gathering as integral parts of achieving heart health for all residents of the Champlain Region.
Within the realm of the CCPN, this Atlas constitutes a valuable resource for future planning, priority setting, and evaluation of the CCPN strategy for helping the residents of Champlain Region achieve better cardiovascular health. At the same time, it is a significant tool for several levels of government, policy makers, organizations, health professionals, as well as the Champlain residents to fight the epidemic of heart disease and stroke in our region by engaging in local/ regional advocacy and education.
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CHAPTER 1: THE CHAMPLAIN REGION AND ITS PEOPLE
Champlain Region Overview
Geographically, the Champlain Region encompasses a significant portion of Eastern Ontario. It covers almost 15,500 square kilometres, following the south side of the Ottawa River from the border with the province of Quebec to Deux Rivières in the northwest, and to the south, following the St. Lawrence River to Iroquois and then stretching across eastern Ontario to Algonquin Park. The Champlain Region includes the following municipal planning areas and counties:
City of Ottawa; Eastern Counties (Prescott & Russell, and Stormont, Dundas & Glengarry); Renfrew County; and Northern parts of Leeds, Greenville & Lanark County.
The geographic boundaries of the Champlain Region align with the boundaries of the Champlain Local Health Integration Network (LHIN), a not-for-profit corporation with a mandate to plan, coordinate and fund health services for the Champlain Region. Fourteen LHINs were created by the Government of Ontario in March 2006 as part of the initiative to transform the health care system and were intended to take on the functions of planning, system integration and service coordination, and evaluation of performance through accountability agreements. Their mission to “build an integrated and accountable health system for people where and when they need it” is based on a strong foundation of local community engagement, comprehensive planning, and appropriate resource allocation.
Figure 1.1: Champlain LHIN of Ontario
SOURCE: Ministry of Health and Long-term Care, www.health.gov.on.ca/transformation/lhin/lhinmap_mn.html
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In many ways, the Champlain Region can be considered a microcosm of the rest of Canada:
Champlain Region is home to over 1.2 million residents, representing about 10% of the Ontario population, with a population density per square kilometre of 72.8 (Table 1.1). Ottawa is the largest of the planning areas with 882,477 residents, and North Lanark/ North Grenville the smallest with 47,989 residents (Table 1.1). Going from east to west, the counties of Champlain with their respective share of the population are the Eastern Counties of Stormont, Dundas & Glengarry (10%) and Prescott & Russell (7%), City of Ottawa (71%), and Renfrew County (9%). As well, Champlain includes a northern part of Leeds-Grenville, and parts of Lanark County; these parts altogether comprise 4% of Champlain’s population. The region boasts a rich diversity of urban and rural communities, as well as socio-economic, cultural, and linguistic populations. There is a strong Francophone presence in Champlain reinforced by its shared border with Quebec. Close to 20% of the population is Francophone (as compared to 23% in Canada). There is also a strong multi-cultural presence in Champlain, with 14% of the population being a member of a visible minority (as compared to 19% in Canada). Champlain differs from Canada the most in economic activity, which is driven mainly by services (especially the public service), where employment requires relatively high levels of education.
The 2009 population estimates revealed a growth in the Champlain Region population of 11.9% since the 2001 Census. The City of Ottawa had the largest growth (14.0%), followed by the Eastern Counties (7.0%) (Table 1.1).
Table 1.1: Champlain District population, 2001 and 2009 2001 % Change Region Population* 2009 Population^ 2001 to 2009 Pop/Sq km Champlain 1,100,330 1,230,938 11.9% 72.8 City of Ottawa 774,072 882,477 14.0% 333.2 Eastern Counties 185,968 199,061 7.0% 38.4 Renfrew County 95,138 101,411 6.6% 14.1 North Lanark/North 45,152 47,989 6.3% 23.3 Grenville**
*Source for 2001: Canadian Census 2001. ^ Source: for 2009 population estimates: Ontario Ministry of Health and Long- Term Care, intelliHEALTH Ontario, Date Extracted: March 2011.
**North Lanark/ North Grenville includes the (northern) parts of Lanark and/or Leeds & Grenville that fall within the boundaries of Champlain Region: North Grenville, Beckwith Township, Carleton Place, Mississippi Mills and Lanark Highlands Township. The population of North Lanark/ North Grenville represents 29% of the Leeds, Grenville & Lanark total.
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Demographic and Social Profile
The 2009 age distribution of the Champlain Region population is presented in Figure 1.2. Approximately one quarter of the population is under 20 years of age, and 13 % is over 65 years of age (Table 1.2). Just over 60% of the population is between the ages of 20 and 65, with population numbers highest for the age group 45 to 49, while ages 50-54 and 40-44 are the second and third highest, respectively. The age distribution for each of the Champlain counties follows a similar pattern (Table 1.2). Renfrew County has the highest percentage of the population over the age of 65 (17.2%) and the lowest percentage of the population under the age of 20 (22.2%).
Figure 1.2: Champlain Region, age characteristics, both sexes, 2009
85+ 80−84 75−79 70−74 65−69 60−64 55−59 50−54 (years) 45−49 40−44 group 35−39
Age 30−34 25−29 20−24 15−19 10−14 05−09 00−04
0 20,000 40,000 60,000 80,000 100,000 120,000
Population
Source for 2009 population estimates: Ontario Ministry of Health and Long-Term Care, intelliHEALTH Ontario, Date Extracted: March 2011.
18
Table 1.2: Age characteristics, by Champlain District Subareas, 2009
% of population <20 years 20 to 65 Region of age years > 65 years Champlain 23.1 63.4 13.5 City of Ottawa 23.0 64.4 12.6 Eastern Counties 24.0 60.7 15.3 Renfrew County 22.2 60.7 17.2 North Lanark/ North Grenville 24.3 61.8 13.9
Source for 2009 population estimates: Ontario Ministry of Health and Long-Term Care, intelliHEALTH Ontario, Date Extracted: March 2011.
The proportion of males to females in the Champlain Region varies somewhat across the age groups (Figure 1.3). Population numbers for males appear to be marginally higher than for females between the ages of 0 and 19 years, however they reverse around the age of 20. By age group 75 to 79 years, male population numbers are increasingly lower than female numbers, and they continue to decline through ages 80 and over.
Figure 1.3: Champlain District population by age group and sex, 2009
Males Females 85 and + 80−84 75−79 70−74 65−69 60−64 55−59 50−54 45−49 40−44 35−39 30−34 25−29 20−24 15−19 10−14 5−9 0-4
54321012345 Percent of Total Population
Source for 2009 population estimates: Ontario Ministry of Health and Long-Term Care, intelliHEALTH Ontario, Date Extracted: March 2011.
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Language
Mother Tongue
In 2006, the majority of the population within the Champlain Region (76.9%) identified English as their mother tongue (first and only official language learned and still understood).
Almost one in five residents of the Champlain Region (18.8%) identified French as their mother tongue, and 1% identified both French and English as their first official language learned. Sixteen percent identified neither French nor English as their first language learned.
Language Spoken Most Often at Home
The 2006 Census showed that English remained the language most often spoken at home (76.9%) in the Champlain Region, followed by French (13.3 %), and other non-official languages (8.4 %) (Figure 1.4).
Figure 1.4: Language spoken most often at home, Champlain Region, 2006
1.4% English 8.4% French 13.4% Other
76.9% English and/or French plus Other
SOURCE: Statistics Canada, 2006 Community Profiles, 2006 Census
Other Languages
The “other”, non-official languages spoken in the Champlain Region have long been associated with immigration. The top 10 mother tongues other than English and French identified in the 2006 Census include: Arabic (1.96%), Chinese (1.47%), Italian (1.03%), German (0.94%), Spanish (0.73%), Polish (0.72%), Cantonese (0.48%), Vietnamese (0.48%), Dutch (0.44%), and Persian (0.41%).
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Francophones in the Champlain Region
There is a strong francophone presence in Champlain, reinforced by its shared border with Quebec. Approximately 18.8% of the population is francophone (4.3% in Ontario, 23% in Canada), making it the region with the highest proportion of Francophones in the province. In 2009, the Ontario government introduced the Inclusive Definition of Francophones which captures those whose mother tongue is neither French nor English, but who have a particular knowledge of French as an Official Language and use French at home, including many recent immigrants to Ontario. This new inclusive definition will increase the number of Francophones in statistics from 2009 onwards. For the purpose of this report, the term “Francophones” designates those who reported French as their sole mother tongue or as one of their mother tongues (single or multiple response) as the data reported is from the 2006 Census. Significantly more Francophones reside in the Eastern Counties of Prescott & Russell, where 67.6% of its population is francophone compared to the next highest sub-planning region, Stormont, Dundas & Glengarry, with a francophone population of 23.5%.
Table 1.3: Distribution of Francophones in Champlain Region, 2006
Francophone Francophones REGION Total Population Population (%)
Ontario 12,028,900 521,500 4.3
Champlain 1,131,355 212,835 18.8
City of Ottawa 835,470 146,360 17.5
Stormont, Dundas & 108,585 25510 23.5 Eastern Glengarry Counties Prescott & Russell 78,740 53200 67.6
Renfrew County 98,130 5,405 5.5
Leeds, Grenville & Lanark 160,370 5,850 3.6
SOURCE: Statistics Canada, 2006 Community Profiles, 2006 Census
Ethnicity
There is a strong multi-cultural presence in Champlain, with 14.9% of the population being a member of a visible minority, compared to 16.2% in Canada. Specifically, 19.4% of the population in the City of Ottawa is a visible minority compared to 3.0% in Stormont, Dundas & Glengarry and less than 2% in the other planning areas.
The majority (approximately 84%) of the Champlain Region population identifies their cultural or racial background as White. A number of other backgrounds including Chinese (2.65%), South Asian (2.11%), Black (3.25%), Filipino (0.46%), Latin American (0.61%), Southeast Asian (0.84%), Arab (1.87%), West Asian (0.48%), Korean (0.14%), and Japanese (0.15%) were also identified (2006 Census).
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Aboriginal Persons
According to the 2006 Census, Aboriginal persons comprised 2.0% of the Champlain Region population. Within the Champlain Region, the county with the highest relative proportion of Aboriginal persons is Renfrew County (5.6%), followed by Prescott & Russell and Leeds, Grenville, & Lanark (both 2.0%). Figure 1.5 presents the total number of Aboriginal persons by sex, county, and for the Champlain Region. Almost 24% of the Aboriginal population in 2006 were less than 15 years of age, and approximately 5% were 65 years and older. The largest proportion of the population (34%) was in the 35 to 55 year age groups (Figure 1.6). A majority of the Aboriginal population in the Champlain Region identify themselves as North American Indian (55%), followed by Métis (36%) (Figure 1.7). The percentage of the population that identifies itself as Aboriginal in Renfrew County is 2 to 3 times greater than in the other sub-planning areas; nevertheless, over half the Aboriginal population of Champlain (12,250 persons) resides within the City of Ottawa. Less than 30% of the Aboriginal population aged 15 years and over have a high school graduation certificate, and unemployment ranges from 8.3% to 13.1% depending on the county of residence (Table 1.4). The Akwesasne reserve, located in the Eastern Counties, is comprised of approximately 10,000 people. The reserve declined to participate in the 2006 Census. Data for this aboriginal group therefore are not included in any of the data in this report.
Figure 1.5: Number of Aboriginal persons, by sex, for Ottawa, Prescott & Russell, Renfrew County, and Leeds, Grenville & Lanark, 2006
25,000
20,000
15,000 Male 10,000 Female Both 5,000 Population 0 Leeds, City of Eastern Renfrew Champlain Grenville & Ottawa Counties County District Lanark Male 6,010 1,950 2,925 1,645 10,830 Female 6,955 1,860 2,645 1,685 11,550 Both 12,970 3,815 5,570 3,330 22,375
SOURCE: Statistics Canada, Aboriginal Population Profile, 2006 Census
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Figure 1.6: Number of Aboriginal persons in Champlain Region, by age group, both sexes, 2006
SOURCE: Statistics Canada, Aboriginal Population Profile, 2006 Census
Figure 1.7: Percentage of the Aboriginal identities within the Champlain Region, 2006
SOURCE: Statistics Canada, Aboriginal Population Profile, 2006 Census
23
Table 1.4: Educational attainment and unemployment status for Aboriginal persons in Ottawa, Prescott & Russell, Renfrew County, and Leeds, Grenville & Lanark, 2006
% of the Aboriginal % of the Aboriginal population ( ≥ 15 years population ( ≥ 15 years REGION of age) with a high of age) with a Unemployment Rates school certificate or university certificate or equivalent degree
City of Ottawa 24.3 17.9 9.2
Stormont, Dundas & 28.1 4.1 13.1 Eastern Glengarry Counties Prescott & Russell 18.2 10.3 8.6
Renfrew County 29.2 3.4 9.8
Leeds, Grenville & Lanark 23.9 3.6 8.3
SOURCE: Statistics Canada, Aboriginal Population Profile, 2006 Census
Income and Employment
The 2009 overall unemployment rate (individuals 15 years and over) and youth unemployment rate (15 to 24 years of age) for the Champlain Region are both lower than the rates for Ontario (Table 1.5). Within the Champlain Region, Leeds, Grenville & Lanark has the highest overall and youth unemployment rates, and Ottawa has the lowest.
Of the Champlain Region population aged 20 years and over in 2006, 6.4% reported having a total household income of less than $20,000. Approximately 14% reported an income between $20,000 and $39,000 and 70.4% reported an income of $40,000 or more. Of those reporting an income greater than $40,000, the largest percentage (30%) reported an income of $100,000 or more (CCHS 3.1).
In 2005, the median income reported for all census families (married couple (with or without children of either or both spouses), a couple living common-law (with or without children of either or both partners) or a lone parent of any marital status, with at least one child living in the same dwelling) was $77,091 in the Champlain Region, compared to $69,156 in Ontario (Statistics Canada, 2006 Community Profiles, 2006 Census).
Education
Of the Champlain Region population aged 20 years and over, 81.8% reported that they graduated from high school, and only 8% reported no post-secondary education. In terms of the highest degree, certificate or diploma obtained, 23.5% reported having completed a college diploma, 18.8% a bachelor’s degree, and 10.4% a university degree or certificate above a bachelor’s degree (CCHS 3.1).
Within the Champlain Region, Ottawa had the lowest percentage of people without high school graduation.
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Table 1.5: Adult and youth unemployment rate in Ontario, Champlain and its District Health Units, 2005 and 2009
2005 2009 REGION ≥ 15 years of 15 to 24 years of ≥ 15 years of 15 to 24 years of age age age age
Ontario 6.6 13.9 9.0 17.6
Champlain 6.6 13.3 6.0 14.0
City of Ottawa 6.7 12.9 5.7 13.5
Eastern Counties 5.2 11.6 6.4 14.2
Renfrew County 6.4 x 7.9 14.9
Leeds, Grenville & Lanark 6.5 14.7 8.0 18.1
SOURCE: Statistics Canada, Labour Force Survey, CANSIM Table 109-5304 x = Suppressed to meet the confidentiality requirements of the Statistics Act
Socio-economic Status
Based on 2006 Census data, 13.8% of Champlain residents were in the lowest income bracket before tax. More females (14.6%) than males (13.0%) are in the lowest income bracket before tax which is slightly lower than provincial rates for males (13.7%) and for females (15.6%). Figure 1.8 is from the Health System Intelligence Project (HSIP) which uses 2001 Census data to summarize multiple indicators including education, employment status, and income, and produced a composite index of relative socio-economic disadvantage for each census subdivision (CSD) of the Champlain LHIN, as part of the Socio-Economic Indicators Atlases provided for each LHIN. Within Champlain, as shown in Figure 1.8, the disadvantage index is highest (red) in CSDs in Renfrew County, in several CSDs in Ottawa, and in Cornwall and Hawkesbury.2 The disadvantage index is lowest (green) in the Russell parts of Prescott & Russell and in the suburban parts of Ottawa. The rural area of Ottawa has the highest household income of all the sub-planning areas.
Health Status
Overall Self-rated Health
A majority (64.5%) of Champlain residents rated their overall health as very good or excellent, while 10.4% of residents rated their overall health as fair or poor (CCHS, 2009).
Access to a Family Physician
Approximately 87.6% of the Champlain Region population, a proportion slightly lower than in Ontario as a whole (91.5%), reported that they have a regular medical doctor. The majority (84.4%) of Champlain residents reported having contact with a medical doctor in the past 12 months which is slightly higher than in Ontario (82.9%) (CCHS, 2009).
25
Figure 1.8: Index of relative socio-economic disadvantage in the Champlain Region
SOURCE: Socio-Economic Indicators Atlas, Champlain LHIN; available at www.champlainlhin.on.ca/lhinresearch.aspx
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CHAPTER 2: BURDEN OF CARDIOVASCULAR DISEASE
Cardiovascular disease (CVD) affects the heart and the circulatory system and includes acute myocardial infarction (AMI), ischemic heart disease (IHD), heart valve disease, peripheral vascular disease (PVD), arrhythmias, high blood pressure, and stroke. CVD is the leading cause of death, hospitalization, and disability in Canada and the Champlain Region. It has been estimated that 1.6 million Canadians have heart disease or are living with the effects of a stroke.3 IHD, a condition characterized by a compromised blood supply to the heart muscle, usually as a result of atherosclerosis or “hardening” of the coronary arteries that supply blood to the heart muscle, accounted for the greatest percentage of cardiovascular deaths (20%).3 Of these, half were attributable to AMI, a type of IHD where prolonged ischemia leads to muscle damage (a heart attack). The Eastern Counties (particularly Prescott & Russell) and Renfrew County of the Champlain Region are amongst the five provincial hot spots for CVD and ischemic mortality with mortality rates higher than the provincial and national rates.4-6
Although CVD is often thought to primarily affect men and older people, statistics show that this disease is a leading cause of death in women and affects men in their prime of life. More than half of all CVD deaths each year occur among women, with the percentage of all deaths due to CVD increasing after the age of 50.3 In men, these rates increase steadily after the age of 40.3 The potential years of life lost (PYLL) for heart disease, an indicator of premature mortality calculated by subtracting the age at which death actually occurred from age 75, is three times as high for men as it is for women.3 Although in Canada, the leading cause of PYLL in 2001 in men was unintentional injuries followed by IHD, the order for Ontario and the Champlain Region was reversed, with IHD being the leading cause of PYLL.5
The mortality data alone severely understate the burden of CVD and the impacts on quality of life. For example, 5.7% of Canadian adults over the age of 20 and nearly 25% of those aged 70 years and over report having heart problems.6 Only 51% of those with self-reported heart disease and 36.8% of those with self-reported stroke rate their health as good or better.3 Activity restrictions are reported by 60% of those with self-reported heart disease and 77.2% of those with self-reported stroke.3
CVD is also the leading contributor to direct and indirect health costs. In 2000, the total cost of heart disease and stroke to the Canadian economy was approximately $22.2 billion ($7.6 billion in direct costs and $14.6 billion in indirect costs) – more than any other disease.3 In Ontario, spending of $5.5 billion has been reported annually on the treatment of CVD.7 Heart disease and stroke combined are the number one cause of hospitalization among men and women in Canada (18% of hospitalizations in 2000-01).3 In addition, premature death due to CVD contributed to an estimated $9.3 billion in lost productivity.3 Unfortunately, more recent data on the economic burden of CVD are not available at the time of this writing.
Although the mortality rates from various forms of CVD have decreased significantly over the past 20 years, with the aging Canadian population and a general growth of the population, the actual numbers of people diagnosed with CVD are expected to increase. For example, based on the provincial population projections, the number of deaths in the CVD category is expected to double by 2018 as a result of population growth and aging.7 Consequently, the burden of CVD on the population is expected to persist.
Prevalence
Prevalence refers to the proportion of the population with a particular disease at a given moment in time Some sense of the prevalence of CVD can be obtained from Statistics Canada Canadian Community Health Survey (CCHS), although this approach is limited by the fact that the collected data are self-reported and thus dependent on the individuals having already been diagnosed with heart disease by a physician as well as
27
Figure 2.1: Percent of population by age group and geography that has self-identified as having a history of stroke, 2009.
SOURCE: 2009 Canadian Community Health Study, Statistics Canada.
Figure 2.2: Percent of population by age group and geography that has self-identified as having heart disease, 2009.
SOURCE: 2009 Canadian Community Health Survey, Statistics Canada.
28
reporting this information correctly in the survey. Looking at Figure 2.1, Champlain had a lower rate of stroke than Ontario. This is the same for heart disease (Figure 2.2) however, in residents 75 and older, Ontario had a lower rate of heart disease than Champlain. For both stroke and heart disease, the prevalence of these conditions increased with age and was the highest in the 75+ group. Males in the Champlain region had a lower rate of stroke (0.6%) and a higher rate of heart disease (4.8%) than females in the Champlain region (0.9%, 2.8%).
Mortality
When describing the burden of CVD, mortality tends to receive the greatest attention due to the availability of the data. In 2005, as shown in Figure 2.3, cancer was the leading cause of death in Champlain Region and Ontario, accounting for 1 in 3 deaths which is a change from 2004 when circulatory diseases was the leading cause of death. IHD accounted for the greatest percentage of total deaths (13%), followed by AMI (7%), and cerebrovascular disease (6%) (Figure 2.4). Data on diabetes are presented given that diabetes and heart disease are closely related with 4 out of 5 people with diabetes expected to die from heart attack or stroke.
Figure 2.3: Percentage of total deaths due to circulatory diseases, cancer and other causes, Champlain Region, 2005
Other Cancer 38% 32%
Circulatory Diseases 30%
SOURCE: Vital Statistics 2005, Provincial Health Planning Database (PHPDB) , Ontario
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Figure 2.4: Percentage of total deaths due to circulatory diseases, cancer and other causes, Champlain Region and Ontario, 2005
ONTARIO CHAMPLAIN 45.0 40 40.0 38 35.0 30 32 30 30 30.0 All Circulatory Diseases 25.0 20.0 15.0 11 13 8 10.0 7 7 6 4 3 5.0 2 2 3 2 0.0 Percentage (%) (%) total deaths of Percentage
Underlying Cause of Death
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
Between 2002 and 2005, the age-standardized mortality rates for AMI, IHD, heart failure, and cerebrovascular disease have been declining in Champlain Region and Ontario (Figures 2.5-2.8). For diabetes (Figure 2.9), the regional rates and provincial rates have declined slightly. Despite the observed declines in mortality rates, due to the aging population and the general growth of the population, the actual numbers of people dying from CVD are expected to increase. Rates were age- and sex-standardized using the standard 2008 Canadian population.
30
Figure 2.5: Age-standardized mortality rates (per 100,000 population) for acute myocardial infarction, 2002-2005
60
50
40
30
20
10
0 2002 2003 2004 2005 Mortality Rate (per 100,000 population) CHAMPLAIN 46.2 45.2 38.9 39.9 ONTARIO 48.7 46.7 42.9 41.1 YEAR
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
Figure 2.6: Age-standardized mortality rates (per 100,000 population) for ischemic heart disease, 2002- 2005
140
120
100
80
60
40
20
0 2002 2003 2004 2005 Mortality Rate (per 100,000 population) 100,000 (per Rate Mortality CHAMPLAIN 118.2 114.9 104.9 107.2 ONTARIO 111.1 108.5 100.3 96.4 YEAR
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
31
Figure 2.7: Age-standardized mortality rates (per 100,000 population) for heart failure, 2002-2005
10.4 10.2 10 9.8 9.6 9.4 9.2 9 8.8 8.6 2002 2003 2004 2005 Mortality Rate (per 100,000 population) 100,000 (per Rate Mortality CHAMPLAIN 9.3 10.3 9.2 9.3 ONTARIO 10.2 9.6 9.3 9.5 YEAR
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
Figure 2.8: Age-standardized mortality rates (per 100,000 population) for cerebrovascular disease, 2002- 2005
45 40 35 30 25 20 15 10 5 0 2002 2003 2004 2005 Mortality Rate (per 100,000 population) 100,000 (per Rate Mortality CHAMPLAIN 38.8 38.1 39.6 32.5 ONTARIO 40.3 38.8 36.3 33.4 YEAR
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
32
Figure 2.9: Age-standardized mortality rates (per 100,000 population) for diabetes, 2002-2005
25
20
15
10
5
0 2002 2003 2004 2005 Mortality Rate (per 100,000 population) 100,000 (per Rate Mortality CHAMPLAIN 20.2 20.6 14.6 17.7 ONTARIO 22.6 22.5 20.7 20.6 YEAR
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
CVD affects men and women differently (Table 2.1). Specifically, more men than women die from AMI and IHD, but more women than men die from heart failure and cerebrovascular disease. Among men, the mortality rates from AMI and IHD increase significantly, and keep rising, after the age of 35; for women, after the age of 45. For heart failure and diabetes, the mortality rates for both sexes increase significantly after the age of 65, and for cerebrovascular disease, after the age of 55. These data confirm that CVD is not a disease of men or old age, but affects both men and women in the prime of their life.
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Table 2.1: Age- and sex-specific mortality rates (per 100,000 population), Champlain Region, 2002-2005
Acute Myocardial Infarction
Females Males
AGE GROUP 2002 2003 2004 2005 2002 2003 2004 2005
35-44 2.0 3.0 1.0 1.0 7.0 2.0 11.0 4.0
45-54 13.0 9.0 3.0 5.0 37.0 26.0 28.0 21.0
55-64 12.0 25.0 10.0 17.0 100.0 89.0 69.0 68.0
65-74 78.0 77.0 84.0 83.0 227.0 199.0 203.0 225.0
75-84 304.0 291.0 292.0 305.0 631.0 683.0 495.0 466.0
85+ 1168.0 1171.0 858.0 960.0 1451.0 1541.0 1489.0 1423.0
All Ages 84.14 85.14 70.99 79.49 120.09 116.56 104.80 102.24 Ischemic Heart Disease
Females Males
AGE GROUP 2002 2003 2004 2005 2002 2003 2004 2005
35-44 4.0 7.0 1.0 3.0 11.0 12.0 17.0 12.0
45-54 27.0 14.0 17.0 8.0 69.0 58.0 64.0 52.0
55-64 43.0 57.0 32.0 54.0 209.0 170.0 189.0 190.0
65-74 246.0 204.0 201.0 185.0 519.0 533.0 466.0 548.0
75-84 836.0 788.0 788.0 737.0 1477.0 1509.0 1308.0 1296.0
85+ 3521.0 3365.0 2909.0 3117.0 4122.0 4336.0 4000.0 3941.0
All Ages 244.7 231.39 212.67 221.32 278.88 279.94 264.11 274.02 Heart Failure
Females Males
AGE GROUP 2002 2003 2004 2005 2002 2003 2004 2005
35-44 0.0 0.0 0.0 1.0 2.0 1.0 2.0 0.0
45-54 0.0 1.0 2.0 0.0 1.0 1.0 3.0 1.0
55-64 2.0 2.0 2.0 0.0 4.0 5.0 5.0 5.0
65-74 8.0 25.0 5.0 17.0 14.0 34.0 22.0 22.0
75-84 64.0 62.0 80.0 83.0 56.0 103.0 86.0 93.0
85+ 629.0 402.0 429.0 449.0 461.0 726.0 447.0 500.0
All Ages 28.77 23.41 24.26 26.89 13.68 23.25 17.74 18.42
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(CONT`D)
Table 2.1: Age- and sex-specific mortality rates (per 100,000 population), Champlain Region, 2002-2005
Cerebrovascular Disease
Females Males
AGE GROUP 2002 2003 2004 2005 2002 2003 2004 2005
35-44 3.0 3.0 5.0 4.0 2.0 3.0 2.0 1.0
45-54 3.0 9.0 4.0 7.0 12.0 8.0 7.0 7.0
55-64 9.0 25.0 29.0 6.0 24.0 19.0 23.0 20.0
65-74 78.0 75.0 91.0 68.0 111.0 109.0 125.0 96.0
75-84 308.0 333.0 340.0 349.0 443.0 447.0 380.0 289.0
85+ 1671.0 1346.0 1681.0 1417.0 1612.0 1871.0 1404.0 1115.0
All Ages 98.99 94.87 110.83 98.1 73.72 77.27 68.69 55.57 Diabetes Females Males
AGE GROUP 2002 2003 2004 2005 2002 2003 2004 2005
35-44 1.0 2.0 0.0 0.0 1.0 1.0 3.0 4.0
45-54 5.0 3.0 2.0 2.0 10.0 12.0 6.0 6.0
55-64 12.0 12.0 10.0 5.0 27.0 48.0 28.0 44.0
65-74 43.0 57.0 29.0 39.0 116.0 101.0 58.0 90.0
75-84 204.0 163.0 157.0 143.0 285.0 280.0 214.0 228.0
85+ 350.0 341.0 277.0 378.0 414.0 616.0 298.0 519.0
All Ages 39.91 37.7 30.55 33.69 46.37 52.39 33.86 46.36
SOURCE: Provincial Health Planning Database (PHPDB), Ontario 2008
The regional disparities in CVD and risk factors within the Champlain Region noted earlier are still present. Specifically, three of the Champlain health regions – Renfrew, Eastern Ontario (in particular Prescott & Russell), and Leeds, Grenville & Lanark – were identified as Ontario “hot spots” for CVD morbidity and mortality, with rates significantly higher than those reported for the City of Ottawa, the province of Ontario, and Canada. All causes of death have decreased since 2004. In the City of Ottawa, vascular diseases, acute myocardial infarction and stroke all decreased steadily over the 2004-2007 period. In the Eastern Counties, only acute myocardial infarction decreased steadily over the 4 year period whereas in Renfrew County all vascular diseases, acute myocardial infarction, stroke and diabetes all steadily decreased between 2005 and 2007. Although data for Leeds, Grenville & Lanark were not available at the time of this writing, the patterns still hold, as shown in Table 2.2.
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Table 2.2: Age-standardized mortality rates (per 100, 000 population), City of Ottawa, Eastern Counties, and Renfrew County, 2004-2007
All Causes of Death
City of Ottawa Eastern Counties Renfrew County 2004 530.5 639.1 670.5 2005 528.9 656.2 642.3 2006 483.0 579.7 609.4 2007 483.9 608.6 617.7 All Vascular Diseases
City of Ottawa Eastern Counties Renfrew County 2004 167.8 212.6 229.5 2005 164.0 212.4 206.9 2006 143.2 191.3 199.2 2007 138.0 203.2 187.9 Acute Myocardial Infarction City of Ottawa Eastern Counties Renfrew County 2004 34.0 48.9 51.5 2005 31.4 62.1 52.1 2006 28.5 49.0 48.5 2007 28.0 48.3 38.0 Ischemic Heart Disease
City of Ottawa Eastern Counties Renfrew County 2004 93.5 132.4 121.5 2005 94.1 149.5 111.4 2006 81.1 121.8 113.9 2007 76.3 126.4 101.6 Heart Failure
City of Ottawa Eastern Counties Renfrew County 2004 8.1 9.9 12.4 2005 9.6 4.9 16.9 2006 9.9 11.4 14.1 2007 6.7 8.2 14.7
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(CONT`D) Table 2.2: Age-standardized mortality rates (per 100, 000 population), City of Ottawa, Eastern Counties, and Renfrew County, 2004-2007
Stroke Cerebrovascular Disease
City of Ottawa Eastern Counties Renfrew County 2004 37.6 42.9 43.3 2005 31.2 30.6 41.9 2006 27.1 33.7 37.0 2007 26.2 34.7 33.2 Diabetes City of Ottawa Eastern Counties Renfrew County 2004 11.5 15.9 30.8 2005 14.9 17.6 28.9 2006 11.1 16.7 25.4 2007 11.4 17.7 23.4
SOURCE: Provincial Health Planning Database (PHPDB), Ontario 2008
Potential Years of Life Lost (PYLL)
Potential years of life lost (PYLL) is an indicator of mortality that occurs prior to the approximate life expectancy (otherwise known as premature mortality). The PYLL rate takes into account the number of deaths, the age at death, and the age structure of the relevant population. It is a useful measure for health planners and policy makers in identifying program priorities for the prevention of premature death. It has been reported that each year in Canada, about 250,000 potential years of life are lost due to cardiovascular diseases.9
PYLL was calculated based on three years of mortality data (2003-2005) for ages 0 to 74. Rates for Champlain Region and Ontario were generated with population estimates for ages 0 to 74 from the middle year (2004) of the three years. Rates were age- and sex-standardized using the standard 2008 Canadian population.
Ischemic heart disease was the leading cause of PYLL for circulatory diseases in Champlain Region and Ontario. The PYLL for AMI and IHD was three times as high and for heart failure twice as high for men as it was for women (Table 2.3). The PYLL for cerebrovascular disease was slightly higher for men than for women, whereas for diabetes, the PYLL was twice as high for men as it was for women in Ontario and three times as high in Champlain.
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Table 2.3: Age- and sex-standardized PYLL rates per 100,000 population (avg. 2003-2005), Champlain Region and Ontario
Champlain Ontario DISEASE Male Female Both Male Female Both All Causes 5,150 3,422 4,275 4,813 2,819 3,806 All Circulatory Diseases 1,028 416 716 1,000 396 692 Acute Myocardial Infarction (AMI) 288 85 184 313 86 198 Heart Failure 31 14 22 28 15 21 Ischemic Heart Disease (IHD) 693 198 441 659 182 415 Cerebrovascular Disease 114 103 108 117 92 104 Diabetes 131 43 86 141 77 108
Hospitalizations
The Provincial Health Planning Database and intelliHealth database provides information on the use of hospital services for CVD and diabetes-related health problems. As shown in Figure 2.10, in addition to being the leading cause of death, CVD is also a major cause of hospitalizations in Champlain Region, accounting for 12% of all admissions. The data presented record each separation from a hospital as one episode of care. As a result, an individual will be counted more than once if he or she has more than one hospital separation, even if it is related to the same health problem. The data have been extracted using the diagnosis most responsible for the length of stay, which is determined by the health care team at the time of hospitalization. Rates were age- and sex-standardized using the standard 2008 Canadian population.
Figures 2.11-2.15 show that the hospitalization rates are consistently lower in Champlain Region than in Ontario. There is a small decrease in the hospitalization rate for IHD, heart failure, cerebrovascular disease and diabetes between 2006 and 2009. The hospitalization rate for AMI shows a non-significant upward trend from 2006 to 2009. Similarly to what has been predicted for mortality, the actual numbers of hospitalizations are expected to increase in the future due to the aging of the population.
Table 2.4 presents the hospitalization rates by age and sex. It is evident that hospitalization rates for all conditions increase dramatically with age. The trends for hospitalization rates for men and women over time parallel the trends observed for mortality, at least for AMI and IHD, where more men than women are hospitalized. For heart failure and stroke, hospitalization rates were comparable. Diabetes-related hospitalizations were consistently higher for men.
The regional disparities in CVD mortality within the Champlain Region reported earlier are similar for CVD- and diabetes-related hospitalization rates. The available hospitalization rates from the Eastern Counties and Renfrew County are disproportionately higher than those observed within the City of Ottawa (Table 2.5).
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Figure 2.10: Percentage of total hospitalizations due to cardiovascular diseases, Champlain Region and Ontario, 2006
Ontario Champlain LHIN
14 12 12 12 All Circulatory Diseases 10 8 6 4 3 3 2 2 2222 1 2 1 0 r es s n s re la et se tio se ilu u b a rc a a sc ia se fa ise t F va D Di In D ar ro Percentage (%) of Total Hospitalizations l t ry ia r He eb to rd ea er ula ca H C rc yo ic Ci M em ll e a A ut ch Ac Is
SOURCE: Health Services 2006, Provincial Health Planning Database (PHPDB) Extracted March, 2008, Health Data and Decision Support Unit, Ontario, MOHLTC
Figure 2.11: Age-standardized hospitalization rates (per 100,000 population) for acute myocardial infarction, 2006-2009
250
200
150 population)
100
Hospitalization Rate 50 (per 100,000
0 2006 2007 2008 2009 CHAMPLAIN 182 222 195 199 ONTARIO 216 234 230 231 Year
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
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Figure 2.12: Age-standardized hospitalization rates (per 100,000 population) for ischemic heart disease, 2006-2009
600
500
400
300
200
100 Hospitalization Rate Hospitalization
(per 100,000 population) (per 100,000 0 2006 2007 2008 2009 CHAMPLAIN 557 493 442 436 ONTARIO 544 505 479 463 Year
Source: Extracted September 2010 from intelliHEALTH, MOHLTC Figure 2.13: Age-standardized hospitalization rates (per 100,000 population) for heart failure, 2006-2009
210
200
190
180
170
160 Hospitalization Rate Hospitalization
(per 100,000 population) (per 100,000 150 2006 2007 2008 2009 CHAMPLAIN 192 177 171 175 ONTARIO 201 193 190 188 Year
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
40
Figure 2.14: Age-standardized hospitalization rates (per 100,000 population) for cerebrovascular disease, 2006-2009
200
150
100
50
Hospitalization Rate Rate Hospitalization 0
(per 100,000 population) 100,000 (per 2006 2007 2008 2009 CHAMPLAIN 159 154 136 135 ONTARIO 172 166 161 160 Year
Source: Extracted September 2010 from intelliHEALTH, MOHLTC Figure 2.15: Age-standardized hospitalization rates (per 100,000 population) for diabetes, 2006-2009
120
115
110
105
100
Hospitalization Rate Rate Hospitalization 95 (per 100,000 population) 100,000 (per
90 2006 2007 2008 2009 CHAMPLAIN 108 110 104 101 ONTARIO 119 115 109 109 Year
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
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Table 2.4: Age- and sex-specific hospitalization rates (per 100,000 population), Champlain Region, 2006-2009
Acute Myocardial Infarction
Females Males
AGE GROUP 2006 2007 2008 2009 2006 2007 2008 2009
20-49 17.4 17.3 16.8 18.2 47.1 77.4 78.2 63.1
50-64 99.1 133.9 114.7 151.5 315.2 407.8 417.8 403.7
65-74 309.9 345.0 277.6 296.4 591.1 742.8 620.0 675.0
75+ 890.3 1013.7 756.6 753.9 1356.9 1503.8 1266.4 1189.0
All Ages 149.1 173.9 138.4 150.7 241.3 309.2 290.1 280.5 Ischemic Heart Disease
Females Males
AGE GROUP 2006 2004 2005 2006 2006 2007 2008 2009
20-49 50.2 35.4 34.4 33.5 155.1 144.6 139.0 120.2
50-64 366.1 311.8 280.6 326.5 1211.0 1064.0 1023.0 935.6
65-74 1027.5 820.5 774.0 724.7 2461.3 2241.5 1940.5 1928.5
75+ 1943.2 1772.9 1375.4 1384.3 3359.8 3004.0 2623.9 2463.9
All Ages 400.3 346.0 296.7 306.1 811.3 739.4 685.1 648.4 Heart Failure
Females Males
AGE GROUP 2006 2007 2008 2009 2006 2007 2008 2009
20-49 2.6 3.0 3.7 7.4 9.7 12.0 9.7 11.5
50-64 64.3 64.8 62.0 90.4 125.9 130.0 138.1 128.1
65-74 340.9 352.0 338.5 337.5 548.2 536.9 512.1 455.6
75+ 1565.1 1417.0 1352.1 1386.4 1912.7 1698.7 1621.0 1516.0
All Ages 201.2 189.2 182.3 195.4 203.3 195.1 191.8 180.6 Cerebrovascular Disease
Females Males
AGE GROUP 2006 2007 2008 2009 2006 2007 2008 2009
20-49 27.6 21.8 23.6 16.7 25.0 23.9 24.2 22.6
50-64 96.4 116.6 87.9 93.6 164.5 142.5 164.9 148.2
65-74 288.5 291.4 295.6 238.0 556.2 565.6 441.8 356.8
75+ 998.0 972.7 835.0 921.4 1133.2 1166.1 864.5 938.0
All Ages 162.9 163.3 144.9 146.2 173.8 173.6 151.6 145.4 (CONT`D next page)
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(CONT`D) Table 2.4: Age- and sex-specific hospitalization rates (per 100,000 population), Champlain Region, 2006-2009
Diabetes
Females Males
AGE GROUP 2006 2007 2008 2009 2006 2007 2008 2009
20-49 40.0 43.6 41.5 39.8 63.5 78.1 73.0 63.1
50-64 75.0 90.7 78.7 79.8 146.1 149.6 165.8 157.5
65-74 174.0 149.2 158.0 121.1 335.9 331.0 293.7 289.3
75+ 316.5 299.8 248.0 280.6 577.4 469.9 415.4 422.8
All Ages 87.7 90.1 82.0 61.3 139.1 143.0 138.4 131.5
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
Table 2.5: Age-standardized hospitalization rates (per 100,000 population) for City of Ottawa, Eastern Counties, and Renfrew County, 2006-2009
All Circulatory Diseases City of Ottawa Eastern Counties Renfrew County 2006 789.3 1368.3 1537.0 2007 748.9 1208.4 1355.7 2008 716.0 1139.5 1254.8 2009 703.9 1126.7 1209.1 Acute Myocardial Infarction City of Ottawa Eastern Counties Renfrew County 2006 121.1 273.7 191.1 2007 157.7 303.4 260.4 2008 141.2 264.8 228.2 2009 143.9 275.6 182.9 Ischemic Heart Disease City of Ottawa Eastern Counties Renfrew County 2006 390.6 756.2 809.3 2007 351.3 648.6 698.4 2008 320.6 571.8 635.5 2009 304.0 573.1 604.8 (CONT’D next page)
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(CONT’D) Table 2.5: Age-standardized hospitalization rates (per 100,000 population) for City of Ottawa, Eastern Counties, and Renfrew County, 2006-2009
Heart Failure City of Ottawa Eastern Counties Renfrew County 2006 131.9 223.5 218.2 2007 124.3 216.8 197.3 2008 121.6 206.8 192.8 2009 128.1 205.3 183.8 Cerebrovascular Disease City of Ottawa Eastern Counties Renfrew County 2006 120.9 165.5 214.6 2007 126.5 147.8 180.9 2008 109.6 139.6 164.1 2009 110.0 129.8 149.7 Diabetes City of Ottawa Eastern Counties Renfrew County 2006 76.7 136.6 224.3 2007 83.8 149.8 219.7 2008 76.7 144.5 218.4 2009 71.1 130.4 220.2
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
Emergency Department Visits and General Practitioner/Family Practitioner Visits
The burden of CVD on the health care system is also evident when examining the rates for emergency department (ED) visits and general practitioner (GP)/family practitioner (FP) visits. Table 2.6 presents the utilization rates of these health services for IHD, cerebrovascular disease and diabetes.8 As was the case for hospitalizations, the rates of ED visits and GB/FP visits in Champlain and Ontario increase dramatically with age for all conditions. For IHD and diabetes, ED and GP/FP visit rates were higher among males than females.. GP/FP visit rates among Champlain Region residents were lower than the provincial rates for IHD and diabetes, but slightly higher for cerebrovascular disease.
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Table 2.6: Emergency Department visit and GP/FP visit rates by age group and sex, per 100, 000 population, Champlain Region and Ontario, 2008
Ischemic Heart Disease ED visit rate GP/FP visit rate Age group, sex Champlain Ontario Champlain Ontario
12-44 35 35 578 918 45-64 418 421 9,172 12,537 65-74 969 993 30,772 40,093 75+ 1,723 1,770 52,022 67,387 Males, 12+ 441 439 12,319 16,096 Females, 12+ 271 287 6,719 9,352 Total, age 12+ 354 362 9,460 12,657 Cerebrovascular Disease
12-44 27 20 659 522 45-64 168 147 4,957 4,191 65-74 486 477 16,469 15,711 75+ 1,145 1,182 46,430 42,368 Males, 12+ 192 189 6,536 6,103 Females, 12+ 187 177 6,684 5,907 Total, age 12+ 189 183 6,612 6,003 Diabetes
12-44 130 129 5,002 6,188 45-64 295 290 29,131 35,970 65-74 550 560 61,652 73,677 75+ 870 773 59,473 67,335 Male 302 300 22,991 27,354 Female 230 225 19,443 23,733 All Ages 266 262 21,180 25,508
Source: Extracted September 2010 from intelliHEALTH, MOHLTC
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CHAPTER 3: RISK FACTORS FOR CARDIOVASCULAR DISEASE
While there are many factors that can influence whether or not someone develops a chronic health condition such as CVD, there is increasing recognition that lifestyle factors play a primary role. In particular, the following nine major, potentially modifiable risk factors have been identified in a worldwide landmark study of patients from 52 countries (INTERHEART)10 to account for over 90% of the population-attributable risk of a first myocardial infarction (heart attack): cigarette smoking, adverse blood lipid profile, high blood pressure, diabetes, abdominal obesity, psycho-social factors, alcohol consumption, lack of daily consumption of fruits and vegetables, and lack of daily exercise. Decreasing these risk factors in the population can have a great impact on reducing the health and the economic burden of this disease. Nine out of ten Canadians have at least one risk factor for heart disease and stroke while four in ten Canadians have three or more risk factors.3 Although the way in which the nine risk factors interact to produce the disease reflects a complex interplay of environmental and constitutional (genetic) influences which remain to be further explored, sufficient knowledge has accumulated over the last few decades to prevent CVD. This knowledge spans the full range of laboratory, clinical, observational, and experimental research. A striking deficiency, however, has been noted in the development and application of appropriate evidence-based prevention and control policies. There is an urgent need to promote community interventions as part of a population-wide CVD prevention strategy. Addressing the modifiable cardiovascular risk factors will prevent not only CVD, but also many other chronic diseases, such as diabetes, cancer, chronic obstructive pulmonary disease, and others that share the same risk factors.
High Blood Pressure
The percentage of all Canadians who reported having been diagnosed as having high blood pressure (≥140/90 mmHg) has increased significantly from 2003 to 2009 (Table 3.1). The prevalence of high blood pressure in Ontario also increased in 2009 (17.2%), and is higher than the national rate (16.9%) (CANSIM Table 105-0501).
Approximately 14.9% of the population in the Champlain Region reported being diagnosed with high blood pressure in 2009, which is lower than both the provincial and national rates. Renfrew County and Leeds, Grenville & Lanark reported the highest rate (18.5%) of high blood pressure. Leeds, Grenville & Lanark had the highest percentage of high blood pressure for males (20.5%). Renfrew County and the Eastern Counties had the highest percentage overall for women (18.0%), although this rate is not significantly different from the national or provincial rates. In contrast, the percentage of females in Ottawa and the Champlain Region with high blood pressure (12.3% and 14.1% respectively), was significantly lower than the national and provincial rates. Interestingly, the percentage of males in Ottawa with high blood pressure increased from 11.1% in 2003 to 16.6% in 2009 (CCHS 3.1). In the Eastern Counties, the percentage of males with high blood pressure decreased significantly from 17.7% in 2003 to 9.9% in 2009, although the 2009 percentage of 9.9 has a high coefficient of variation and needs to be used with caution.
Figure 3.1 shows the percentage of the general population who reported having been diagnosed with high blood pressure by age group for the Champlain Region and respective health units. Approximately 42% of the population in the 65 and older age group and 22% in the 44 to 65 age group reported having high blood pressure in the Champlain Region. Data was not reportable for the other age groups due to high sampling variability.
Of the population in Champlain that reported having been diagnosed with high blood pressure, 21% indicated that they had taken medication for high blood pressure within the last month (data not shown).
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Table 3.1: Percentage (95% CI) of general population aged 12 and over who reported having been diagnosed by a health professional as having high blood pressure, by sex, 2003 and 2009 Region 2003 2009 Both Male Female Both Male Female Canada 14.4 13.4 15.4 16.9 16.4 17.3 (14.2, 14.7) (13.0, 13.8) (15.1, 15.8) (16.5, 17.3) (15.8, 17.0) (16.8, 17.9) Ontario 14.8 14.4† 15.1 17.2 17.1 17.4 (14.3, 15.2) (13.8, 15.1) (14.5, 15.6) (16.5, 17.9) (16.0, 18.1) (16.4, 18.4) Champlain 14.9†‡ 15.6 14.1†‡ F F F (12.8, 16.9) (12.3, 19.0) (11.7, 16.5) City of 12.3†‡ 11.1†‡ 13.4 14.4‡ 16.6 12.3†‡ Ottawa (10.8, 13.8) (8.9, 13.3) (11.1, 15.8) (11.7, 17.1) (12.1, 21.0) (9.2, 15.4) Eastern 17.7†‡ 16.9† 17.3 14.0* 9.9†‡*E 18.0 Counties (14.1, 21.2) (13.7, 20.1) (14.9, 19.7) (10.8, 17.2) (5.7, 14.2) (13.1, 22.9) Renfrew 16.9 16.7 17.1 18.5 19.0 E 18.0 County (14.2, 19.6) (12.8, 20.6) (13.6, 20.6) (14.5, 22.4) (11.4, 26.6) (12.5, 23.5) Leeds, 15.6 14.7 16.4 18.5 20.5 E 16.5 Grenville & (13.3, 17.8) (11.3, 18.1) (13.5, 19.3) (14.5, 22.5) (13.8, 27.3) (11.3, 21.6) Lanark
SOURCE: Statistics Canada, Canadian Community Health Survey, CANSIM Table 105-0501 † Statistically significant from the national rate ‡ Statistically significant from the provincial rate * Statistically significant from the 2003 CCHS cycle E Use with caution F Data not reportable due to high sampling variability
Please note: For all tables in this Chapter, the above legend will apply.
Figure 3.1: Percentage (95%CI) of general population who reported having been diagnosed by a health professional as having high blood pressure, by age group, 2009
70 45 to 64 65 and over 53.8 46.5 60 38.6 42.4 40.8 50
40 22.4E 23.4E 18.6E 17.9 19.4 30
20
10
Percentage (%) Percentage 0 Champlain City of Ottawa Eastern Counties Renfrew County Leeds, Grenville & Lanark
SOURCE: Statistics Canada, Canadian Community Health Survey , CANSIM Table 105-0501
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Tobacco Smoking
Smoking Status
The prevalence of current or daily smokers in 2009 in the Champlain Region was approximately 18% (Tables 3.2), a rate consistent with that of Ontario and Canada. Within the Champlain Region, the highest rates in 2009 were reported for Renfrew County (26.8%), followed by Eastern Counties (26.1%) and Leeds, Grenville & Lanark (26.0%). The rates for Renfrew and Eastern Counties were significantly higher than both provincial and national rates. In Table 3.3, the rates for those who report daily smoking in the Champlain Region (12.8%) was lower than those reporting daily or occasional smoking (18.0%).
Table 3.2: Percentage (95% CI) of general population aged 12 and over who reported being a current smoker (daily or occasional), by sex, 2003 and 2009 Region 2003 2009 Both Male Female Both Male Female Canada 23.0 25.1 21.0 20.1* 22.6* 17.7 (22.7, 23.4) (24.6, 25.6) (20.5, 21.5) (19.6, 20.7) (21.8, 23.4) (17.1, 18.4) Ontario 22.3† 25.0 19.6† 18.6† * 21.8 15.4† (21.6, 22.9) (24.1, 26.0) (18.8, 20.4) (17.7, 19.4) (20.5, 23.1) (14.4, 16.5) 18.0 Champlain 20.3 15.9 F F F (16.5, 24.2) (12.3, 19.4) (15.2, 20.9) City of 19.8†‡ 21.8 18.0 14.6†‡ 16.2†‡ 13.2 †E Ottawa (17.5, 22.2) (18.3, 25.2) (14.8, 21.1) (11.0, 18.2) (11.4, 21.0) (8.7, 17.7) Eastern 23.9 23.0 24.8‡ 26.1†‡ 29.7‡ 22.5‡ Counties (21.2, 26.6) (19.1, 26.9) (21.1, 28.5) (21.1, 31.1) (22.2, 37.1) (16.5, 28.5) Renfrew 27.5†‡ 28.7 26.4‡ 26.8†‡ 34.5†‡* 19.9 E County (23.2, 31.9) (22.6, 34.8) (20.5, 32.4) (20.5, 33.1) (25.1, 43.9) (12.1, 27.7) Leeds, 27.4 30.9 24.0 26.0 29.5 22.5 E Grenville & (23.6, 31.2) (25.4, 36.4) (18.7, 29.4) (20.5, 31.5) (21.1, 38.0) (15.1, 29.9) Lanark
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Table 3.3: Percentage (95% CI) of general population aged 12 and over who reported being a current smoker, daily, by sex, 2003 and 2009 Region 2003 2009 Both Male Female Both Male Female Canada 17.9 19.5 16.3 15.6* 17.5* 13.7 (17.6, 18.2) (19.0, 20.0) (15.9, 16.8) (15.1, 16.0) (16.8, 18.2) (13.1, 14.3) Ontario 16.8† 18.8† 14.9† 14.4† 16.8 12.2† (16.3, 17.4) (18.0, 19.6) (14.2, 15.6) (13.6, 15.2) (15.6, 18.0) (11.2, 13.2) Champlain 12.8† 14.5 11.2 F F F (10.5, 15.1) (11.5, 17.6) (8.0, 14.3) City of 14.0†‡ 15.8† 12.3†‡ 9.4†‡ 10.8†‡ E 8.1†‡ E Ottawa (12.1, 16.0) (12.6, 19.1) (9.7, 14.8) (6.7, 12.1) (7.2, 14.3) (4.2, 12.0) Eastern 20.2‡ 19.5 20.9†‡ 20.7†‡ 21.5 19.9†‡ Counties (18.3, 23.5) (15.8, 23.2) (17.4, 24.4) (16.1, 25.3) (14.6, 28.3) (14.2, 25.7) Renfrew 22.0†‡ 21.6 22.3†‡ 22.4†‡ 27.9†‡ 17.5 E County (18.0, 26.0) (16.1, 27.2) (16.4, 28.3) (16.5, 28.4) (19.0, 36.7) (9.7, 25.4) Leeds, 21.5†‡ 23.5 19.6 21.1†‡ 27.2†‡ 15.0 E Grenville & (17.9, 25.2) (18.3, 28.8) (14.7, 24.4) (15.6, 26.7) (18.6, 35.9) (8.7, 21.3) Lanark SOURCE: Statistics Canada, Canadian Community Health Survey, CANSIM Table 105-0501
Age at Initiation of Smoking
Thirty-three percent of residents within the Champlain Region in 2008 reported initiating smoking between the ages of 5 and 14 years (Table 3.4). This is significantly lower than the Canadian proportion. Renfrew County reported the highest percent (39.8%), followed by Eastern Ontario (38.4%), and Ottawa the lowest (30.3%). Age at initiation of smoking appears to have remained fairly stable between 2003 and 2008, within both Champlain and the province.
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Table 3.4: Percentage (95% CI) of general population who reported initiating smoking between the ages of 5 and 14 years, by sex, 2003 and 2008 Region 2003 2008 Both Male Female Both Male Female Canada 37.2 39.1 35.1 36.9 38.7 34.8 (36.7, 37.7) (38.4, 39.8) (34.3, 35.8) (36.4, 37.4) (38.1, 39.4) (34.1, 35.4) Ontario 32.9† 36.2† 29.1† 33.7† 35.9† 30.8† (32.1, 33.7) (34.9, 37.4) (28.0, 30.2) (32.9, 34.5) (34.7, 37.1) (29.6, 31.9) Champlain 34.1 36.1 31.9 33.4† 35.7 30.8 (31.3, 36.9) (32.3, 40.0) (28.3, 35.4) (30.9, 36.0) (32.0, 39.4) (27.3, 34.2) City of 33.5 36.4 30.4† 30.3† 31.8† 28.3† Ottawa (29.8, 37.2) (31.2, 41.5) (25.7, 35.0) (26.9, 33.8) (26.8, 36.7) (23.8, 32.7) Eastern 37.7 37.1 38.4‡ 38.4 42.6 33.3 Counties (33.9, 41.5) (31.6, 42.6) (33.0, 43.8) (33.9, 42.9) (36.2, 49.0) (26.9, 39.6) Renfrew 40.4‡ 43.9 36.6 39.8 38.6 41.0 County (34.7, 46.2) (36.1, 51.7) (28.9, 44.3) (34.3, 45.3) (30.6, 46.7) (34.1, 47.9) Leeds, 33.7 33.3 34.2 37.5 42.9 31.9 Grenville & (28.7, 38.7) (26.6, 40.0) (27.1, 41.2) (32.8, 42.2) (36.2, 49.5) (26.2, 37.6) Lanark
Source: Canadian Community Health Survey, Annual Component 2007-2008,Public Use Microdata File
Exposure to Second-hand Smoke in the Past Month in Public Places
Exposure to second-hand smoke improved between 2003 and 2009 (Table 3.5). The reported rates across Canada and Ontario were lower by about 10 % in 2009 as compared with 2003. In 2009, Canada and Ontario had a similar rate of reported exposure to second-hand smoke for males and females. The introduction of smoke-free policies across Ontario may be largely responsible for this observed rate. The Champlain region and the City of Ottawa had statistically significant lower rates of exposure to second hand smoke than Ontario and Canada. The other regions also reported lower rates of exposure to second-hand smoke which were more similar to the Ontario and Canada rates.
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Table 3.5: Percentage (95% CI) of general population who reported exposure to second-hand smoke in the past month, in vehicles and/ or public places, by sex, 2003 and 2009
Region 2003 2009 Both Male Female Both Male Female Canada 24.3 27.4 21.5 14.6 16.0 13.3 (23.9, 24.8) (26.7, 28.0) (21.0, 22.1) (14.0, 15.2) (15.2, 16.9) (12.6, 14.0) Ontario 22.7† 25.5† 20.2† 15.0 16.3 13.9 (22.0, 23.4) (24.4, 26.6) (19.3, 21.1) (14.1, 16.0) (14.9, 17.8) (12.6, 15.1) Champlain 11.2†‡ 12.0†‡ 10.5‡ F F F (8.9, 13.4) (8.4, 15.5) (7.7, 13.3) City of 18.9†‡ 18.5†‡ 19.3 10.4†‡ 10.1†‡ E 10.6 E Ottawa (16.5, 21.4) (14.9, 22.1) (15.9, 22.7) (7.7, 13.1) (6.1, 14.1) (7.0, 14.2) Eastern 21.2 24.3 18.2 13.9 E 18.4 E 9.9 E Counties (18.2, 24.2) (19.7, 28.9) (14.4, 22.0) (9.4, 18.4) (9.7, 27.0) (4.8, 15.0) Renfrew 20.9 23.1 18.9 14.0 E 10.0 E F County (16.4, 25.3) (16.7, 29.5) (13.1, 24.6) (7.0, 21.1) (3.8, 16.2) Leeds, 23.0 25.3 21.0 15.1 E 20.4 E 10.1 E Grenville & (19.4, 26.6) (19.3, 31.3) (16.0, 25.9) (9.5, 20.7) (10.5, 30.2) (5.0, 15.2) Lanark
SOURCE: Statistics Canada, Canadian Community Health Survey, CANSIM Table 105-0501
Diabetes
Diabetes has been described as one of the most important threats to the health of people in developed countries.11 It is predicted that between 2007 and 2017, 1.9 million Canadians will develop diabetes.11 The percentage of the general population who reported having been diagnosed with diabetes is presented in Table 3.6. Nationally, the prevalence of diabetes increased significantly from 4.6% in 2003 to 6.0% in 2009. The percentage of males and females with diabetes both increased significantly from 4.9% to 6.6% and from 4.3% to 5.3% respectively. Similar patterns were observed in Ontario and the Champlain Region. The data for the Champlain region and its sub-regions should be used with caution due to high sampling variability. In 2009, the Eastern Counties had the highest prevalence of diabetes (8.5%) while the City of Ottawa had the lowest prevalence of diabetes (5.5%).
The age group with the highest prevalence of diabetes in 2009 was the 65 and over group, followed by the 45 to 64 years age group. Data for the other age groups was not reported due to high sampling variability. Approximately 17.6% of Champlain Region residents in the 65 and over age group reported having diabetes. The Eastern County reported the highest rates of diabetes for that age group with a reported rate of 20.3% (Figure 3.2). The City of Ottawa reported the lowest rate of diabetes for the 65 and over age group with a reported rate of 16.1%.
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Table 3.6: Percentage (95% CI) of general population aged 12 and over who reported having been diagnosed by a health professional as having diabetes, by sex, 2003 and 2009
Region 2003 2009 Both Male Female Both Male Female Canada 4.6 4.9 4.3 6.0 6.6 5.3 (4.4, 4.8) (4.7, 5.2) (4.1, 4.5) (5.7, 6.2) (6.2, 7.1) (5.0, 5.7) Ontario 4.6 4.8 4.4 6.4† 6.9 6.0† (4.3, 4.9) (4.4, 5.2) (4.0, 4.8) (5.9, 7.0) (6.2, 7.6) (5.3, 6.7) Champlain 6.1 7.2 E 5.0 E F F F (4.4, 7.8) (4.6, 9.7) (3.0, 7.1) City of 4.2 4.7 3.7 E 5.5 E 6.0 E 4.9 E Ottawa (3.2, 5.2) (3.3, 6.1) (2.3, 5.1) (3.3, 7.6) (2.9, 9.1) (2.1, 7.7) Eastern 5.5 6.5 E 4.5 E 8.5 E 11.0 E 6.1 E Counties (4.1, 6.9) (4.2, 8.8) (2.7, 6.3) (5.5, 11.5) (5.7, 16.3) (2.9, 9.3) Renfrew 5.8 7.0 E 4.7 E 7.1 E 4.5 E County (4.1, 7.4) (4.4, 9.5) (2.4, 7.0) (3.8, 10.4) F (1.6, 7.5) Leeds, 5.8 6.7 E 4.9 E 6.2 E 7.6 E 4.9 E Grenville & (4.2, 7.4) (4.3, 9.1) (2.9, 6.9) (3.8, 8.6) (3.4, 11.7) (2.2, 7.6) Lanark
SOURCE: Statistics Canada, Canadian Community Health Survey, CANSIM Table 105-0501
Figure 3.2: Percentage (95% CI) of general population who reported having been diagnosed by a health professional as having diabetes, by age group, Champlain Region and Health Units, 2009
45 to 64 65 and over 35 30 25 20 15
Percentage (%) Percentage 10 5 7.9E17.6E 6.4E 16.1E 13.3E 20.3E 0 19.6E 0 19.0E 0 Champlain City of Ottawa Eastern Counties Renfrew County Leeds, Grenville and Lanark
SOURCE: Statistics Canada, Canadian Community Health Survey, CANSIM Table 105-0411
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Overweight & Obesity
In 2009, 33.4% of the population within the Champlain Region had a BMI based on self-reported information classified as overweight (Table 3.7), and 17.9% as obese (Table 3.8). The self-reported prevalence was highest in the 45 to 64 years age group (Figure 3.3).
The prevalence of overweight or obese youth (aged 12 to 17) was approximately 15.2% in 2007 and 18.4% in 2009 (Table 3.9). Low population counts for these categories however, mean that these rates must be interpreted with caution. Statistics Canada did not report data for 2003 due to high sampling variability.
Table 3.7: Percentage (95% CI) of general population aged 18 and over whose BMI based on self-reported information indicated overweight (25.00 to 29.99), by sex, Canada, Ontario, Champlain Region, and Health Unit, 2003 and 2009
Region 2003 2009 Overweight Obese Both Male Female Both Male Female Canada 34.1 41.3 26.8 33.7 40.2 27.2 (33.7, 34.5) (40.7, 41.9) (26.3, 27.3) (33.0, 34.4) (39.1, 41.2) (26.3, 28.0) Ontario 34.2 41.2 27.2 34.0 40.1 27.8 (33.5, 34.9) (40.1, 42.2) (26.3, 28.1) (32.8, 35.1) (38.4, 41.8) (26.3, 29.3) Champlain 33.4 39.8 27.4 F F F (29.3, 37.6) (33.6, 46.0) (22.7, 32.1) City of 36.2 44.8 27.7 31.5 39.0 24.3 Ottawa (33.5, 38.9) (40.8, 48.9) (23.7, 31.7) (26.2, 36.8) (30.9, 47.2) (18.6, 30.1) Eastern 41.3†‡ 52.5†‡ 29.8 40.0 41.9 38.2†‡* Counties (37.9, 44.7) (47.5, 57.5) (25.6, 34.0) (33.3, 46.8) (33.7, 50.1) (28.9, 47.5) Renfrew 37.2 39.4 35.1†‡ 39.1 45.0 33.4 County (32.3, 42.0) (32.2, 46.5) (28.9, 41.3) (31.9, 46.3) (34.2, 55.9) (24.1, 42.7) Leeds, 36.6 45.3 27.9 37.1 38.8 35.4† Grenville & (32.2, 41.0) (38.3, 52.3) (22.6, 33.2) (31.2, 43.1) (29.7, 47.9) (27.6, 43.3) Lanark
SOURCE: Statistics Canada, Canadian Community Health Survey, CANSIM Table 105-0501
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Table 3.8: Percentage (95% CI) of general population aged 18 and over whose BMI based on self-reported information indicated obese (30.00 or higher), by sex, 2003 and 2009
Region 2003 2009 Both Male Female Both Male Female Canada 15.3 16.0 14.5 17.9 19.0 16.7 (14.9, 15.6) (15.6, 16.5) (14.0, 14.9) (17.4, 18.4) (18.2, 19.8) (16.0, 17.4) Ontario 15.2 16.1 14.4 17.4 18.6 16.3 (14.7, 15.8) (15.4, 16.8) (13.6, 15.1) (16.6, 18.3) (17.3, 19.9) (15.1, 17.4) Champlain 17.9 19.4 16.4 F F F (14.9, 20.9) (15.1, 23.8) (12.4, 20.5) City of 13.0†‡ 12.7†‡ 13.3 15.6 17.3 13.7 E Ottawa (10.3, 15.1) (9.7, 15.6) (10.3, 16.4) (11.8, 19.4) (12.1, 23.1) (8.6, 18.8) Eastern 19.3†‡ 20.4 18.1 25.7†‡ 25.7 E 25.8†‡ Counties (16.6, 22.0) (16.3, 24.5) (14.5, 21.7) (19.7, 31.8) (16.7, 34.6) (18.5, 33.2) Renfrew 18.7 19.3 18.1 22.0 22.7 E 21.3 E County (14.6, 22.8) (13.3, 25.3) (12.7, 23.6) (16.3, 27.7) (13.8, 31.7) (12.8, 29.8) Leeds, 18.6†‡ 19.0 18.1 22.6 28.1‡ E 16.9 E Grenville & (15.3, 21.8) (14.3, 23.8) (13.4, 22.8) (16.8, 28.4) (18.8, 37.4) (9.9, 23.8) Lanark
SOURCE: Statistics Canada, Canadian Community Health Survey, CANSIM Table 105-0501
Table 3.9: Percentage (95% CI) of Champlain Region youth aged 12 to 17 whose BMI based on self-reported information indicated overweight or obese, 2007 and 2009
Region 2007 2009 Both Male Female Both Male Female Champlain 15.2 E 22.2 E 18.4 E 20.9 E 15.7 E F (7.8, 22.6) (9.0, 35.4) (10.6, 26.1) (7.9, 33.9) (6.8, 24.7) SOURCE: Statistics Canada, Canadian Community Health Survey, 2007 and 2009. CANSIM Table 105-0501
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Figure 3.3: Percentage of general population in the Champlain Region whose BMI based on self-reported information indicated overweight or obese, by age group, 2009
Overweight Obese 50
40
30
20
10
Percentage (%) 26.810.2 29.8 18.3 39.9 19.9 34.5 28.1 0 20-34 34-44 45-64 65+ Age group (years)
SOURCE: Statistics Canada, Canadian Community Health Survey (CCHS 3.1), 2009
Physical Inactivity
In 2009, 47.5% of the Canadian population and 49.3% of the Ontario population reported being physically inactive during their leisure time (daily energy expenditure less than 1.5 kcal/kg/day). The prevalence in the Champlain Region was significantly lower at 41.6%. (Table 3.10).
The highest rates of physical inactivity were reported in the Eastern Counties (49.2%) and Renfrew County (44.0%). The lowest rates were reported in the city of Ottawa. The prevalence of physical inactivity was also higher for females than males across the Champlain Region, Ontario, and Canada.
Self-reported physical inactivity rates generally increased across age groups for both males and females, especially in the 45 to 64 and 65 and over age groups (Figure 3.4). In the 12 to 19, 20 to 34 and 65 and over age groups, female rates of inactivity were higher than male rates.
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Table 3.10: Percentage (95% CI) of general population aged 12 and over who reported being physically inactive, 2003 and 2009 Region 2003 2009 Both Male Female Both Male Female Canada 48.2 44.9 51.4 47.5 43.6 51.3 (47.8, 48.7) (44.3, 45.5) (50.8, 52.0) (46.9, 48.2) (42.7, 44.6) (50.4, 52.1) Ontario 48.6 45.1 52.0 49.3 45.2 53.3 (47.9, 49.3) (44.0, 46.1) (51.0, 53.0) (48.3, 50.4) (43.7, 46.8) (51.8, 54.8) Champlain 41.6†‡ 38.0†‡ 45.0†‡ F F F (37.6, 45.7) (32.6, 43.5) (40.0, 50.0) City of 43.5 39.1 47.7 39.7†‡ 37.5†‡ 41.7†‡ Ottawa (40.5, 46.6) (34.9, 43.3) (43.5, 51.8) (34.3, 45.0) (30.3, 44.6) (35.3, 48.1) Eastern 50.5 49.6 51.3 49.2 39.8 58.5 Counties (47.3, 53.7) (44.8, 54.4) (47.0, 55.6) (42.6, 55.9) (30.3, 49.3) (48.7, 68.4) Renfrew 48.1 44.3 51.5 44.0 40.4 47.2 County (43.5, 52.7) (38.2, 50.4) (45.1, 57.9) (35.3, 52.6) (28.0, 52.9) (36.3, 58.0) Leeds, 47.8 46.1 49.4 42.2 41.1 43.4 Grenville & (43.4, 52.2) (40.0, 52.1) (43.1, 55.7) (35.8, 48.7) (31.0, 51.3) (34.7, 52.1) Lanark
SOURCE: Statistics Canada, Canadian Community Health Survey, CANSIM Table 105-0501
Figure 3.4: Percentage (95% CI) of general population in the Champlain Region who reported being physically inactive, by age group, 2009
Both Male Female 80.0 70.0 60.0 50.0 40.0 30.0 20.0 Percentage (%) Percentage 43.7 10.0 64.7 42.9 35.1 32.5 44.8 44.9 55.2 34.126E 38.1 33E 44.2 38.4 44.7 0.0 12 to 19 20 to 34 34 to 44 45 to 64 65 and over Age Group (years)
SOURCE: Statistics Canada, Canadian Community Health Survey -3226, CANSIM Table 105-0501
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Adequate Consumption of Fruit & Vegetables
In 2009, approximately 45% of the population in Canada, Ontario, and the Champlain Region reported consuming at least the recommended five servings of fruit and vegetables per day. The percentage of men who reported eating the recommended servings was significantly lower than women across all regions (Table 3.11) (CANSIM 105-0501).
Fruit and vegetable consumption in Canada, Ontario and the City of Ottawa has increased between 2003 and 2009. In the Eastern Counties there was a small increase from 2003 to 2009, but consumption decreased in Renfrew County as well as Leeds, Grenville & Lanark. These regions consumed significantly less fruit and vegetables than Champlain, Ontario, and Canada. This is especially true for males.
Table 3.11: Percentage (95% CI) of general population aged 12 and over who reported consuming at least 5 servings of fruit and vegetables per day, by sex, 2003 and 2009 Region 2003 2009 Both Male Female Both Male Female Canada 41.1 34.5 48.0 45.6 39.7 51.4 (40.9, 41.8) (33.8, 35.1) (47.4, 48.6) (44.9, 46.3) (38.7, 40.7) (50.4, 52.3) Ontario 41.9 35.8 47.6 44.1 38.9 49.1 (41.1, 42.6) (34.7, 36.9) (46.6, 48.7) (43.0, 45.2) (37.3, 40.5) (47.6, 50.6) Champlain 45.7 38.1 53.2 F F F (42.1, 49.3) (33.0, 43.2) (48.4, 57.9) City of 43.5 36.0 50.6 48.0 40.3 55.3 Ottawa (40.6, 46.5) (32.2, 39.9) (46.5, 54.7) (43.3, 52.6) (33.8, 46.7) (49.1, 61.6) Eastern 40.9 33.6 47.9 44.5 41.0 48.3 Counties (37.7, 44.1) (29.0, 38.2) (43.5, 52.3) (39.1, 50.0) (32.8, 49.2) (40.5, 56.1) Renfrew 39.2 31.9 45.8 32.3†‡ 19.3†‡ 44.1 County (34.4, 44.0) (26.0, 37.8) (39.1, 52.6) (25.0, 39.6) (11.8, 26.8) (33.1, 55.2) Leeds, 39.1 31.6 46.0 37.6†‡ 32.0 43.2 Grenville & (35.4, 42.9) (26.3, 36.9) (40.8, 51.1) (31.5, 43.8) (22.9, 41.1) (35.5, 51.0) Lanark
SOURCE: Statistics Canada, Canadian Community Health Survey, CANSIM Table 105-0501
As of 2008, Canada’s Food Guide now issues specific recommendations for consumption of fruit and vegetables by age and gender. The recommendations can be found at http://www.hc-sc.gc.ca/fn-an/food-guide- aliment/index-eng.php
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CHAPTER 4: RISK FACTORS BY SOCIO-ECONOMIC STATUS
Socio-economic status (SES), as defined by education, income, occupation, social status, and neighbourhood environment, is an important contributor to health. Associations between SES and a number of health outcomes including all-cause mortality, CVD mortality, and risk factor prevalence have been established; however, the mechanism underlying this relationship remains uncertain. Data from the National Population Health Survey in Canada (1994-95 and 2002-03) indicated that among middle-aged adults aged 45 to 64, socio-economic characteristics such as level of education and household income were more important determinants of healthy aging than lifestyle behaviours.12 There is also evidence that CVD is related in part to poverty in combination with excessive psycho-social stress and the adoption of unhealthy coping behaviours.13 Similarly, diabetes in Canada appears to be more prevalent among the poor and disadvantaged.14 Income and employment are intricately related to adequate access to heart healthy food, and in general, SES dictates health behaviours, access to medical care, and long-term stress.
The evidence on the CVD-SES relationship continues to accumulate and suggests that in order to fully address the burden of CVD, programs and policies addressing socio-economic variables need to become part of strategies and interventions targeting the traditional cardiovascular risk factors.
Household Income
Looking at cardiovascular risk factors by household income in 2008, it is evident that the self-reported prevalence of high blood pressure, diabetes, and smoking was lower within higher household income groups (Figure 4.1).
The prevalence of physical inactivity was lower within higher household income groups (Figure 4.1). The consumption of fruit and vegetables was fairly constant across income levels, while the percentage of persons overweight tended to increase with household income. The prevalence of obesity decreased as household income increased.
Education
Looking at self-reported cardiovascular risk factors by level of education in 2008 (Figure 4.2), it appears that for both the prevalence of high blood pressure and diabetes there was a decrease in the prevalence as educational attainment increased.
Levels of activity, consumption of less than the recommended five daily servings of fruit and vegetables, smoking and overweight or obese status do not change significantly based on educational attainment (Figure 4.2).
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Figure 4.1: Percentage of Champlain population aged 12 and over with self-reported cardiovascular risk factors, by household income group, 2008
80.0
70.0
60.0
50.0
40.0
Percentage (%) 30.0
20.0
10.0
0.0 < 5 Fruit High Blood Daily Physically Diabetes Veg Overweight Obese Pressure Smoker Inactive Servings LOWEST 19.6 8.9 24.6 54.0 58.3 27.1 22.6 LOWER_MIDDLE 23.2 7.7 24.0 48.6 56.4 30.3 20.5 MIDDLE 19.8 6.5 17.6 43.5 52.3 29.7 17.3 UPPER_MIDDLE 14.3 3.7 16.2 43.4 53.1 30.4 16.9 HIGHEST 11.4 2.3 9.8 35.6 50.5 31.7 14.5
Cardiovascular Risk Factors
SOURCE: Statistics Canada, Canadian Community Health Survey, Public Use Microdata File, 2007-2008
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Figure 4.2: Percentage of Champlain population with self-reported cardiovascular risk factors, by highest degree, certificate or diploma obtained, 2008
90.0
80.0
70.0
60.0
50.0
40.0
Percentage (%) 30.0
20.0
10.0
0.0 < 5 Fruit High Blood Daily Physically Diabetes Veg Overweight Obese Pressure Smoker Inactive Servings Less than secondary 19.6 6.3 17.8 36.1 50.4 21.8 13.9 Secondary 17.8 5.4 23.9 47.9 60.2 33.0 19.6 Post Secondary 14.4 3.8 13.2 41.5 51.6 32.4 18.1
SOURCE: Statistics Canada, Canadian Community Health Survey, Public Use Microdata File, 2007-2008
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CHAPTER 5: CHAMPLAIN COMMUNITY HEART HEALTH SURVEY
SURVEILLANCE GAPS & FUTURE DIRECTIONS
As is the case globally, nationally, and provincially, CVD is the leading cause of death, hospitalization, and disability in the Champlain Region. Evidence affirms that CVD is largely preventable and that targeted public health efforts can help reduce its negative impact. Effective prevention must occur at the national as well as provincial and local levels and requires timely, actionable, population-based information on CVD and related risk factors, including temporal and geographical trends. Such information will guide the delivery of primary and secondary preventive health services, programs, and policies to where they are needed the most and where they can be expected to have the greatest impact. The availability of such information depends on our ability to measure and monitor the state of CVD and the corresponding burden on the health care system. In the absence of a robust surveillance system, the available data are limited and fragmented.
Current surveillance efforts in Canada include collection of demographic, mortality, morbidity, risk factor prevalence, and related health care data. Although these are available, they are often limited in their scope, data collection procedures, and generalizability. National population surveys often lack an adequate sample size and the geographical representation to allow comparisons on a sub-provincial regional level. Typically, the smaller the jurisdiction, the smaller the sample, and the higher the variability of the data collected. Consequently, the extent to which the findings and conclusions can be applied to the community at large is significantly limited.
There is also a paucity of data on the burden of CVD among special groups and high risk populations. Aboriginal status, for example, has been included in some national surveys however, the sample size is too small to draw conclusion at the level of the LHIN. Community-based surveillance studies generally have small numbers of predominantly white communities, emphasize disease prevalence, and include little longitudinal follow-up. In general, events rather than individuals are tracked, making it difficult to determine incidence or the rate of occurrence of new cases. In addition, they are often restricted to in-hospital events and do not capture the evolving detection and treatment of CVD in the outpatient setting.
Levels of risk factors in the population are determined from self-reports with no current data on physical and biochemical measures of risk. Although some sense of disease and risk factor prevalence can be obtained through this approach, the validity of self-reported data has been questioned as research shows a discrepancy between self-reported and objectively measured data. Self-reports are dependent not only on the individuals having already been diagnosed with the condition by a physician, but also on their reporting of this information correctly in the survey. In addition, self-reports are also subject to the social-desirability bias in the results, which may contribute to an underestimation of the prevalence of certain risk factors (i.e. obesity, physical inactivity, poor diet).
The last survey that included a comprehensive collection of cardiovascular-related physical measures - the Canadian Heart Health Survey (CHHS) - was conducted between 1986 and 1992 and did not include data on the residents of the Champlain Region. It has not been repeated in most provinces, leaving a void in information on control of major risk factors, including high blood pressure and dyslipidemia. Launched in 2007, the Canadian Health Measures Survey was developed to collect direct measures of health from 5,000 Canadians, aged 6 to 79, and randomly selected from 15 sites across the country. The Champlain Region was not selected as one of the collection sites. The survey took place between 2007 and 2009, and began to be disseminated in late 2009.
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The currently available local data on CVD and risk factor rates, including temporal and geographical trends, are not available in a timely, on-going manner. Information on the physical and biochemical measures of risk is lacking altogether. This, in turn, forces health care providers and administrators to access customized databases yielding comparisons limited in scope and generalizability. The need for a robust information system capable of supplying meaningful and actionable data to health care providers, patients, consumers, and decision-makers was identified as a priority by the CCPN and its Monitoring, Surveillance & Evaluation Expert Panel. As part of the regional efforts to develop systems to monitor trends, risk factors, and behaviours in the Champlain Region, the Champlain Community Heart Health Survey (CCHHS) was launched in August 2008.
THE CHAMPLAIN COMMUNITY HEART HEALTH SURVEY (CCHHS)
The CCHHS is a collaborative effort led by the CCPN and the international PURE (Prospective Urban and Rural Epidemiologic) Study being coordinated from McMaster University. The PURE study is a large-scale epidemiological study that plans to recruit approximately 140,000 individuals residing in >600 communities in 17 low-, middle-, and high income countries around the world. In Canada, the study is being conducted in Hamilton, Vancouver, Laval and the Champlain region. The CCHHS is a community-based survey is designed to collect key information relevant to the cardiovascular health and lifestyles of the residents of the Champlain Region, using a standardized data collection methodology designed for tracking lifestyles, risk factors, and outcomes in urban and rural settings.
The survey involved collecting physical measures (blood pressure, height and weight, waist to hip ratio, body fat, blood cholesterol and glucose tests) as well as completion of questionnaires related to lifestyles, current health status, medical history, nutrition, physical activity, smoking habits, and alcohol use. This information was collected from over 1400 randomly polled residents of the Champlain Region, with longitudinal, yearly follow up. The initial (baseline) data collection period began in September 2008 and was completed in September 2009. The follow-up survey is scheduled to begin in June 2011. The survey will become an ongoing part of Champlain Region’s health information system. With regular monitoring of the temporal and geographic distribution and trends in CVD and risk factor rates, real benchmarks will be established by which to measure progress and to guide the future planning, priority setting, and evaluation of primary and secondary prevention efforts by health care providers and organizations within the Champlain Region.
DATA ANALYSIS
The next few pages show the results from the baseline survey (n=1439). Most of the tables were generated using the SAS procedure “surveyfreq”. The procedure took into account that the data were clustered by community and that each observation had an associated weight. The weight variable shows how many observations are represented by each observation in the survey. A few tables were generated using the mean procedure in SAS to average results taking into account the weight variable associated with each observation.
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CCHHS RESULTS
The results of the survey show heterogeneity of the population demographics. The majority of the participants are currently married (66.0%) which is higher than reported for Champlain by the 2006 Census. Under half of the participants (41.6%) are of European descent, with 36.1% being of an “Other” ethnicity not listed on the survey.
Table 5.1 Marital Status by Gender and Urban/Rural Residence
Census 2006 (Champlain Marital Status Female Male Urban Rural Total LHIN) % CV % CV % CV % CV % CV % Never Married 10.6 17.1 8.1 22.9 11.4 17.4 4.4 18.0 9.4 0.3 33.5 Currently Married 56.3 4.9 77.1 3.8 64.3 9.2 71.5 14.0 66.0 0.1 49.8 Common Law 8.3 15.0 7.1 12.7 6.7 16.8 10.2 16.3 7.7 0.2 8.7 Widowed 10.1 29.0 0.8 21.6 6.2 26.3 3.8 16.2 5.5 0.3 6.0 Separated 2.8 22.6 3.0 18.7 3.4 19.1 1.7 16.8 2.9 0.2 3.4 Divorced 12.0 11.4 4.0 20.3 7.9 11.3 8.5 18.8 8.1 0.1 7.3 Total 100.0 100.0 100.0 100.0 100.0 Source: Champlain Community Heart Health Data (CCHHS), 2011
Table 5.2 Champlain population by Ethnicity for Gender and Urban/Rural categories
Female Male Urban Rural Total Ethnicity % CV % CV % CV % CV % CV South Asian 0.4 8.8 1.7 6.7 1.0 5.8 0.4 14.5 0.9 0.4 Chinese 1.6 8.2 1.6 8.5 2.2 6.6 N/A N/A 1.6 0.5 Japanese 0.1 15.2 0.1 16.8 0.2 9.5 N/A N/A 0.1 0.7 Other Asian 0.8 6.9 N/A N/A 0.5 7.3 0.2 12.8 0.4 0.5 Persian 0.5 10.2 0.7 10.4 0.8 5.5 N/A N/A 0.6 0.4 Arab 0.8 9.6 1.2 7.9 1.2 5.5 0.7 16.1 1.0 0.4 Black African 1.4 6.6 0.3 11.9 1.2 5.0 0.1 16.1 0.9 0.4 Subsaharan African 0.5 11.2 1.4 16.8 1.3 10.3 N/A N/A 0.9 0.8 European 38.4 1.5 44.9 1.67 46.9 2.2 28.7 6.0 41.6 0.1 Native 3.8 3.4 3.0 5.2 3.2 3.5 4.0 7.7 3.4 0.2 Latin American 0.1 15.2 1.0 7.1 0.6 5.8 0.3 16.1 0.6 0.4 Other 40.0 1.5 32.0 2.3 26.1 2.7 60.0 5.2 36.1 0.1 Missing 11.8 1.8 12.4 4.9 14.8 3.3 5.5 5.6 12.1 0.2 Total 100.0 100.0 100.0 100.0 100.0 Source: Champlain Community Heart Health Data (CCHHS), 2011
Participants in the study had a high education level with 72.5% having a college level degree which is higher than reported by the 2006 Census for the Champlain region (56.1%). The second highest level of educational attainment was the completion of secondary school (20.4%) which was slightly lower than what the Census reported (24.0%). Education levels were higher in the urban setting (79.8%) versus the rural setting (54.95%). With the Government of Canada being the major employer in Ottawa, it is not surprising to see such high levels of education in the urban area.
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Table 5.3 Champlain Population by Education for Gender and Urban/Rural categories
Census 2006 (Champlain Female Male Urban Rural Total LHIN) Education % CV % CV % CV % CV % CV % None 0.0 0.0 0.1 43.5 0.0 0.0 0.2 24.7 0.1 1.0 11.6 Primary 0.6 17.3 1.0 15.8 0.6 26.4 1.2 10.3 0.8 0.3 N/A Secondary 24.9 6.9 15.7 8.1 14.8 15.5 34.0 8.1 20.4 0.1 24.0 Trades 2.1 13.7 7.2 14.2 3.1 20.9 8.5 12.3 4.6 0.3 8.3 College 71.5 2.4 73.6 3.0 79.8 9.4 54.9 8.2 72.5 0.0 56.1 Unknown 0.0 45.0 0.0 0.0 0.0 0.0 0.1 24.7 0.0 1.0 N/A Missing 0.9 14.9 2.4 15.5 1.8 27.8 1.3 11.8 1.6 0.3 N/A Total 100.0 100.0 100.0 100.0 100.0 100.0 * Please note, for the Census percentages, numbers were calculated based on the total population aged 35 to 64 as this group most closely reflected the population of the Champlain Community Heart Health Survey. The percentage for College in the Census data includes the categories of College, CEGEP and university certificate/degree. Source: Champlain Community Heart Health Data (CCHHS), 2011
Table 5.4 Medical History & Diagnosis
Female Male Urban Rural Total CCHS 2009 Medical History Mean Mean Mean Mean Mean CV CV CV CV CV (%) (%) (%) (%) (%) (%) Chest Pain 9.3 0.2 9.5 0.2 7.4 0.1 14.3 0.1 9.4 0.1 N/A If yes, does pain spread to back, 36.7 0.2 44.2 0.2 29.6 0.3 55.5 0.2 40.4 0.2 N/A neck or inner border of arm Diagnosis Diabetes 6.0 0.2 8.5 0.2 5.7 0.1 10.8 0.2 7.2 0.1 6.1
Hypertension 21.4 0.2 20.0 0.1 19.5 0.1 23.8 0.1 20.7 0.1 14.9
Stroke 1.0 0.4 1.1 0.4 0.6 0.4 1.9 0.5 1.0 0.3 N/A Angina/Heart Attack 1.9 0.3 5.7 0.2 3.0 0.2 5.7 0.2 3.8 0.2 N/A Heart Failure 0.5 0.6 1.2 0.4 0.5 0.6 1.5 0.4 0.8 0.4 N/A Other Heart Disease 2.7 0.3 2.1 0.3 2.4 0.3 2.4 0.2 2.4 0.2 N/A Cancer 10.8 0.4 4.3 0.2 8.5 0.3 5.4 0.2 7.6 0.3 N/A
COPD 1.7 0.3 1.8 0.5 1.8 0.4 1.7 0.5 1.7 0.3 3.8
Asthma 13.2 0.1 8.7 0.1 11.5 0.1 9.8 0.1 11.0 0.1 9.1 Source: Champlain Community Heart Health Data (CCHHS), 2011
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The rates of certain cardiovascular risk factors and diseases were slightly higher in this study than those observed in Canadian Community Health Survey (CCHS). For instance, the rate of diabetes in the study was 7.2% which is slightly higher than the national rate (6.0%) and Champlain rate (6.1%) as reported in the CCHS 2009. Similar results were found for hypertension. The study had an overall hypertension rate of 20.7% with rates in the rural region begin slightly more elevated (23.8%). CCHS reports that 16.9% of the population has hypertension that has been diagnosed by a health professional while the Champlain rate is reported as 14.9%.
Table 5.5 Years Since Diagnosis
Female Male Urban Rural Total Condition % CV % CV % CV % CV % CV Diabetes 8.9 15.3 6.7 17.2 7.3 17.5 8.0 15.4 7.6 16.5
Hypertension 7.5 15.1 9.5 18.2 8.3 19.3 8.8 15.2 8.4 17.3
Stroke 3.1 3.7 7.4 4.0 5.2 7.6 6.7 5.1 6.1 5.9 Angina/Heart 4.5 13.5 8.4 19.2 9.5 19.4 5.7 15.6 7.7 18.3 Attack Heart Failure 1.0 N/A 4.0 18.5 2.8 14.6 4.0 20.9 3.6 20.0 Other Heart 22.8 17.7 12.5 17.6 15.9 18.9 27.3 13.0 18.4 18.1 Disease Cancer 10.6 14.3 12.7 19.0 11.2 19.6 11.2 12.1 11.2 16.4
COPD 6.5 18.9 15.6 11.9 11.2 22.1 11.9 8.3 11.4 15.2
Asthma 18.6 15.8 22.7 15.5 19.6 18.2 22.9 10.8 20.3 15.7 Source: Champlain Community Heart Health Data (CCHHS), 2011
Table 5.6 Medications
Female Male Urban Rural Total % CV % CV % CV % CV % CV On Medication 59.3 0.1 46.6 0.1 51.5 0.1 56.9 0.1 53.1 0.1 On medication for:
Blood Pressure 36.6 0.2 50.4 0.1 40.1 0.1 47.2 0.1 42.5 0.1 Cholesterol 20.5 0.2 53.0 0.1 30.2 0.1 41.1 0.1 33.8 7.0 lowering drugs Stroke 0.2 0.8 1.6 0.4 0.4 0.6 1.5 0.4 0.8 0.4
Diabetes 7.2 0.3 17.0 0.2 9.7 0.2 14.5 0.3 11.3 0.2
Asthma 10.9 0.2 7.6 0.2 10.1 0.3 8.3 0.1 8.5 0.2
Others 85.6 0.0 59.8 0.1 75.2 0.0 73.2 0.1 74.6 0.0
Unknown 7.3 0.6 7.2 0.1 4.5 0.6 11.8 0.6 7.2 0.4 Source: Champlain Community Heart Health Data (CCHHS), 2011
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The distribution of medication use shows a greater proportion of women on medications than men overall, however for cardiovascular related risk factor control, the proportion of men on medications exceeds that of women. In general a larger percentage of individuals in rural areas compared to urban areas are on medications for cardiovascular related conditions. Across the region, blood pressure control appears to be the leading condition followed by lowering of cholesterol and control of glucose.
Table 5.7 Tobacco Use
Female Male Urban Rural Total CCHS 2009 Smoking % CV % CV % CV % CV % CV % History Formerly used 35.5 0.1 35.1 0.1 34.0 0.1 38.3 0.1 35.3 0.1 N/A tobacco Currently use 11.2 0.2 11.4 0.2 9.4 0.2 15.6 0.2 11.3 0.1 18.0 tobacco Never used 53.3 0.1 53.6 0.1 56.6 0.1 45.8 0.1 53.4 0.1 N/A tobacco Total 100.0 100.0 100.0 100.0 100.0 * The CCHS data includes current daily and occasional smokers. The question in the CCHHS asked only if the participant currently uses tobacco. Source: Champlain Community Heart Health Data (CCHHS), 2011
Eleven percent of participants in the study currently use tobacco which is lower than the rate reported for Champlain by the CCHS (Table 5.7). Those in rural regions had a higher rate of smoking (15.9%) than those in the urban region (9.4%). The overwhelming majority (85.5%) of participants began smoking between the ages of 11 and 20 years of age. There were no significant differences between gender or geographical location for the age of smoking initiation (Table 5.8). The average number of cigarettes smoked per day was 16 (Table 5.9).
Table 5.8 Age Started Smoking
Female Male Urban Rural Total Age Started % CV % CV % CV % CV % CV Smoking 0-10 years old 1.9 0.6 2.6 0.3 1.6 0.5 3.4 0.4 2.2 0.3
11-20 years old 83.2 0.0 88.0 0.0 86.3 0.0 84.0 0.0 85.5 0.0
21-30 years old 11.6 0.2 8.0 0.3 9.6 0.2 10.1 0.2 9.8 0.1
31-40 years old 2.7 0.4 1.1 0.6 1.9 0.5 2.0 0.3 1.9 0.3
41-50 years old 0.6 0.8 0.4 1.0 0.5 0.8 0.5 1.1 0.5 0.6
51-60 years old 0.2 1.0 N/A N/A 0.2 1.0 N/A N/A 0.1 1.0
61+ years old N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A – data not available Source: Champlain Community Heart Health Data (CCHHS), 2011
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Table 5.9 Smoking History
Female Male Urban Rural Total Cigarettes Mean CV Mean CV Mean CV Mean CV Mean CV Average amount 13.0 13.5 19.0 11.6 15.0 15.4 19.0 9.4 16.0 12.9 per day Duration (years) 17.5 15.0 21.6 12.1 17.7 16.8 22.9 9.4 19.5 13.6 When stopped 23.7 13.6 20.7 11.2 23.1 15.3 20.9 9.4 22.3 12.9 (years ago) Cigars and Pipes Average amount 1.4 28.8 2.8 29.4 2.0 28.5 4.0 22.7 2.7 29.4 per day Duration (years) 9.6 20.0 8.8 18.4 8.4 22.8 10.0 12.6 8.8 18.3 When stopped 12.0 N/A 20.9 10.7 21.2 9.7 19.4 9.7 20.9 10.6 (years ago) Source: Champlain Community Heart Health Data (CCHHS), 2011
Participants in the study reported a higher level of exposure to secondhand smoke than nationally reported data. Approximately 26% of participants reported that they are regularly exposed to secondhand smoke with more females (28.8%) than males (23.9%) reporting exposure to secondhand smoke. Participants from rural regions also reported higher levels of exposure (33.8%). According to the Canadian Health Measures Survey (CHMS), 11.2% of Champlain residents reported exposure to secondhand smoke in the past month while 14.6% of Canadians reported exposure to secondhand smoke in the past month.
Table 5.10 Exposure to Second Hand Smoke
Female Male Urban Rural Total % CV % CV % CV % CV % CV Regular exposure to 28.8 0.2 23.9 0.2 23.1 0.2 33.8 0.1 26.5 0.1 secondhand smoke Typical Exposure 1-2 times per week 47.6 0.2 65.0 0.2 62.0 0.2 44.5 0.3 55.2 0.1
3-6 times per week 16.5 0.5 5.8 0.4 7.0 0.3 19.5 0.6 11.9 0.4
At least once a day 16.8 0.3 10.0 0.5 14.0 0.2 13.7 0.3 13.9 0.1
2-3 times per day 4.5 0.5 7.8 0.5 3.8 0.7 9.3 0.4 5.9 0.4 4 or more times per 14.5 0.5 11.4 0.5 13.2 0.7 13.1 0.3 13.2 0.4 day Source: Champlain Community Heart Health Data (CCHHS), 2011
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Table 5.11 Physical Measurements
Female Male Urban Rural Total Physical Mean CV Mean CV Mean CV Mean CV Mean CV Measurements Systolic Blood 126.4 0.2 131.0 0.2 127.6 0.1 131.2 0.3 128.7 0.2 Pressure (mmHg) Diastolic Blood 74.7 0.1 77.9 0.1 75.2 0.1 78.8 0.1 76.2 0.1 Pressure (mmHg) Waist 83.6 0.2 95.8 0.1 87.7 0.2 93.9 0.2 89.5 0.2 Circumference (cm) Weight (kg) 71.3 0.2 87.5 0.2 77.7 0.3 82.9 0.2 79.2 0.2 Hip Circumference 104.1 0.1 104.5 0.1 103.6 0.1 105.9 0.1 104.3 0.1 (cm) Height (cm) 162.5 0.1 175.9 0.1 169.2 0.1 168.6 0.1 169.0 0.1 Source: Champlain Community Heart Health Data (CCHHS), 2011
Although there are differences in physical measures between men and women, they are within normal limits reflecting the overall health of the participants. This may reflect a volunteer effect, ie individual concerned about their health and looking after themselves for the most part, being more likely to participate in such a survey, rather than a true indication of the levels in the overall population of Champlain.
CCHS 2009 data for this Chapter was obtained from Health Profile available at CCHS data http://www12.statcan.ca/health-sante/82- 228/details/page.cfm?Lang=E&Tab=1&Geo1=HR&Code1=3511&Geo2=PR&Code2=35&Data=Rate&SearchText=Champlain%20Health%20 Integration%20Network&SearchType=Contains&SearchPR=01&B1=All&Custom=
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FUTURE DIRECTIONS
CVD is the leading cause of death and hospitalization for residents of the Champlain Region. One of the main objectives of the CCHHS was to determine which areas of the Champlain Region are at greatest risk for CVD, thereby allowing clinical and public health professionals to better target their interventions to serve those populations. Using some of the preliminary data from the CCHHS data, the following risk assessment was conducted on the data from the CCHHS15. The sample size is too small to accurately predict variability between the different postal codes however, we hope in the future to be able to provide additional analyses of this type.
GIS Maps of Framingham Risk Score for Hard Coronary Heart Disease in the Urban Ottawa Area
The Framingham Hard Coronary Heart Disease risk tool can be used to estimate the percentage risk of developing a myocardial infarction or coronary death over a 10-year period. The tool is designed for adults aged 20 years of age and older. The tool calculates risk based on age, gender, total cholesterol levels, HDL (good) cholesterol levels, cigarette smoking, systolic blood pressure and treatment for high blood pressure. The risk is calculated in a range from: less than 1% to greater than a 30% chance of developing a myocardial infarction or coronary death over the next 10 years.
Female risk rates across urban Ottawa remain low ranging from less than 1% (yellow) to 2% (purple).
Figure 5.1: Percentage Risk of Females Developing a Heart Attack or Coronary Death Over the Next 10 Years in Select Ottawa Population.
Mapping for demonstration purposes only.
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Male percentage risk rates demonstrate greater variability across urban Ottawa and vary from 3% (yellow) to 16% (red).
Figure 5.2: Percentage Risk of Males Developing a Heart Attack or Coronary Death Over the Next 10 Years in Select Ottawa Population.
Mapping for demonstration purposes only.
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REFERENCES
1. Beaglehole R, Saracci R, Panico S. Cardiovascular diseases: Causes, surveillance, and prevention. International Journal of Epidemiology 2001;30:S1.
2. Health System Intelligence Project. Socio-economic indicators atlas: Champlain LHIN. ; Spring 2006.
3. Public Health Agency of Canada. Tracking heart disease and stroke in Canada. ; 2009.
4. Naylor D. Summary, reflections and recommendations in cardiovascular health & services in ontario. institute for clinical evaluative sciences (ICES). ; 1999.
5. University of Ottawa Heart Institute. Population heart health profile champlain district, ottawa. ; 2005.
6. Chow C-, Donovan L, Manuel D, Johansen H, Tu J. Regional variation in self-reported heart disease prevalence in canada. Canadian Journal of Cardiology, CCORT Atlas Paper 2005;21(14):1265-1271.
7. Chan B, Young W. Burden of cardiac diseases. In: David C. Naylor, Pamela M. Slaughter, editors. Cardiovascular health and services in ontario: An ICES atlas. Institute of Clinical Evaluative Sciences; 1999. .
8. Health System Intelligence Project. Chronic conditions in the Champlain LHIN. ; October 2007.
9. Heart and Stroke Foundation of Canada. 2011 heart and stroke foundation report on canadians' health. ; Feb 5, 2011.
10. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L, INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet 2004;364:937- 952.
11. Institute for Clinical Evaluative Services. How many canadians will be diagnosed with diabetes between 2007 and 2017? ICES investigative report. ; June 2010.
12. Martel L, Bélanger A, Berthelot J-, Carrière Y. Healthy aging: Healthy today, healthy tomorrow? findings from the national population heart survey components of statistics canada, catalogue 82-618-MWE2005004. ; 2005.
13. Raphael D, Farrell ES. Beyond medicine and lifestyle: Addressing the societal determinants of cardiovascular disease in north america. Leadership in Health Services 2002;15(4):1-5.
14. Health Council of Canada. Why health care renewal matters: Lessons from diabetes. A health outcomes report. ; March 2007.
15. Green K. Master's thesis.
16. Becker R, Silvi J, Ma Fat D, L'Hours A, Laurenti R. A method for deriving leading causes of death. Bulletin of the World Health Organization 2006;84:297-304.
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APPENDICES
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DATA SOURCES
Chapter 1
Data Sources
Population and demographic statistics for the Champlain Region and associated health regions were derived from Statistics Canada 2006 Community Profiles and the Ontario Ministry of Health and Long-Term Care intelliHEALTH database. The population and demographic statistics for Aboriginal persons were derived from the Statistics Canada 2006 Aboriginal Population Profile.
Demographic data including unemployment, education, access to a family physician and overall self-rated health were derived from the 2009 and 2005 (3.1) cycle of the Canadian Community Health Survey (CCHS). Income and unemployment rates were derived from the Statistics Canada Labour Force Survey.
Data Notes
CCHS
Champlain Region data were derived using LHIN geographic region of residence code. Data for each respective Public Health Unit were derived using the health region of residence code. Note that the Leeds, Grenville & Lanark District Health Unit’s boundary extends beyond the boundary of the Champlain LHIN.
Chapter 2
Data Sources
Hospitalization and mortality data were derived from the Ministry of Health and Long-term Care, Provincial Health Planning Database (PHPDB) and intelliHEALTH.
Data Notes
Mortality Numbers and Rates
The numbers of deaths across a calendar year are for individuals who reside within the region of interest (i.e. Champlain Region, Ontario). ICD 10 codes for the Underlying Cause of Death were utilized (Table 2.1). Age- and sex-specific rates were calculated using year-specific PHPDB population estimates for the region of interest. Age-standardized rates were calculated using the standard 2008 Canadian population.
Hospitalizations
The numbers of inpatient discharges across a calendar year are for individuals who reside within the region of interest (i.e. Champlain Region, Ontario). ICD 10 codes for the most responsible diagnosis were utilized (Table 2.1). Age- and sex-specific rates were calculated using year-specific PHPDB population estimates for the region of interest. Age-standardized rates were calculated using the standard 2008 Canadian population.
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ICD 10 CA Codes
The ICD 10 codes used to derive hospitalization and mortality data are presented in the table below. These codes are consistent with the recommendations put forward by the World Health Organization.16
Table: ICD 10 codes used for hospitalization and mortality data Disease ICD 10 Codes Cancer C00 – C97 Circulatory Disease I00 – I99 Acute Myocardial Infarction (AMI) I21 – I22 Heart Failure I50 – I51 Ischemic Heart Disease I20 – I25 Stroke / Cerebrovascular Disease I60 – I69 Diabetes E10 – E14 SOURCE: World Health Organization, International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), available online at http://www.who.int/classifications/apps/icd/icd10online/
Chapters 3 and 4
Data Sources
Data presented within this chapter were derived from the 2009 cycle of the Canadian Community Health Survey (CCHS).
Data Notes
CCHS Data
Champlain Region data were derived using LHIN geographic region of residence code. Data for each respective Public Health Unit were derived using the Health Region of residence code. Note that the Leeds, Grenville & Lanark District Health Unit’s boundary extends beyond the boundary of the Champlain LHIN.
Household income was calculated based on the total income from all sources in the 12 months before the CCHS interview (see table below):
Household Income Group Total Household Income Lowest Income <$20,000 Lower-middle $20,000-$39,999 Middle $40,000-$59,999 Upper-Middle $60,000-79,999 Highest $80,000 or more SOURCE: Statistics Canada, Canadian Community Health Survey (CCHS 3.1), 2008
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GLOSSARY OF TERMS
Acute Myocardial Infarction (AMI) Also called a heart attack. This occurs when a blood clot completely blocks one of the arteries that provides oxygen-rich blood to the heart.
Age-standardized Rates Represents what the crude rate would be if the population under study had the age distribution of the standard population.
Atherosclerosis The build-up of fat, calcium, and other substances under the inner lining of an artery. Atherosclerosis may cause the arteries to the heart to become narrower, leading to angina or a heart attack.
Body Mass Index (BMI) A method of measuring body weight while taking height into account. It is calculated by dividing weight (in kilograms) by height (in meters) squared (weight/height2).
Canadian Community Health Survey (CCHS) A survey conducted every two years by Statistics Canada to provide regular and timely cross-sectional estimates of health determinants, health status, and health system utilization for health regions across the country. The CCHS began in 2000-01, replacing the National Population Health Survey. The CCHS collects health-related information from the Canadian population focusing on health status, health care utilization, and determinants of health.
The CCHS has a sample size of 130,000 respondents and targets persons aged 12 years or older who are living in private dwellings in all 122 Health Regions in Canada. Persons living on Indian Reserves or Crown lands, residents of institutions, full-time members of the Canadian Armed Forces, and residents of certain remote regions are excluded from the survey. Interviews are done in person using computer-assisted interviewing. The CCHS is unique because of its focus on collecting data at the sub-provincial level, giving health researchers the ability to report regional data as well as national and provincial level data.
Canadian Health Measures Survey (CHMS) The Canadian Health Measures Survey is a national survey that collects information from Canadians about their general health and lifestyles. The Canadian Health Measures Survey will collect key information relevant to the health of Canadians in the form of direct physical measurements such as blood pressure, height and weight, blood and urine sampling and physical fitness testing. Also, through questionnaires, it will gather information related to nutrition, smoking habits, alcohol use, medical history, current health status, sexual behaviour, lifestyle, physical fitness, as well as demographic and socioeconomic variables.
Statistics Canada collected data for the Canadian Health Measures Survey (CHMS) from about 6,000 people in 15 communities randomly selected across Canada between March 2007 and February 2009. The second cycle is currently underway and will be complete in 2011.
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Coefficient of Variation (CV) The ratio of the standard deviation to the mean. It provides a relative measure of the variation. Guidelines for the release or publishing of data estimates are based on the coefficient of variation. Only marginal and acceptable estimates have been included within this publication.
Type of Estimate CV (in %) Acceptable 0.0 ≤ CV ≤ 16.5 Marginal 16.6 < CV ≤ 33.3 Unacceptable CV > 33.3
Confidence Interval (CI) The computed interval (range) with a given probability (e.g. 95%) of which the true value of a variable is contained.
Congestive Heart Failure (CHF) Also called heart failure.
Coronary Artery Disease (CAD) Also called ischemic heart disease, or heart disease.
Diabetes Mellitus A disease characterized by an elevation in blood sugar that can lead to many long-term complications.
Diagnostic Codes (ICD 10) A set of internationally accepted codes for classification of medical diagnosis, conditions, and procedures.
Epidemiology The study of the distribution and determinants of health-related states or events in specific populations and the application of this study to control of health problems.
Ethnicity A term for the ethnic group to which people belong. Usually refers to group identity based on culture, religion, traditions, and customs.
Household Income Group Household income was calculated based on total income from all sources in the 12 months before the CCHS interview:
Household Income Group Total Household Income Lowest Income <$20,000 Lower-middle $20,000-$39,999 Middle $40,000-$59,999 Upper-Middle $60,000-79,999 Highest $80,000 or more
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Hypertension High blood pressure.
Incidence The number of new events (e.g. new cases of a disease) in a defined population within a specified period of time.
Incident Rate The rate at which new events occur in a population within a defined period.
Ischemic Heart Disease (IHD) Also called coronary artery disease.
Local Health Integration Network (LHIN) LHINs are not-for-profit corporations in Ontario that work with local health providers and community members to determine the health service priorities of their regions. They were created in April 2006 and took on their full role of planning and funding health services April 1st, 2007.
Mean Also called the average. Computed by adding all the individual values in a group and dividing by the number of values in the same group.
Morbidity Sickness, the state or condition of being unwell.
Mortality Death.
Mortality Rate Death rate. A statistic calculated by dividing the number of deaths for a specified condition by the number of people in a specified population.
Obesity The presence of excessive body fat.
Prevalence The number of events in a given population at a designated time.
Physical Inactivity Daily energy expenditure less than 1.5 kcal/kg/day.
Risk Factor An aspect of behaviour, way of living, biological characteristic, genetic trait, health related condition, or environmental exposure with predictable effects on the risk of disease due to a specific cause.
Stroke A sudden loss of brain function caused by the interruption of flow of blood to the brain (ischemic stroke) or the rupture of blood vessels in the brain (hemorrhagic stroke).
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