How healthy are we? 2007

ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH How healthy are we? / 2007 Keeping you informed Data notes Urban sprawl andpopulationhealth 1 Health through theages 3 Population Health statistics by publichealthservice area A word from theMedicalOfficer ofHealth Table ofcontents Seniors Adults Children andyouth Babies Nojack MacKay Wildwood Evansburg University ofAlberta,providing integrated health and northernAlberta,theNorthPrairies, Capital Healthactsasareferral centre to central Entwistle Capital HealthinEdmonton isCanada’s largest providing specialized services suchastrauma Tomahawk services to more thanonemillionresidents Westview in andthesurrounding area. and burntreatment, organ transplants health region andisaffiliated withthe Fallis Hutterite Colony Wabamun St. Francis Highway 16 and high-riskobstetrics. Warburg 44 36 56 28 55 17 9 8 5 Genesee Mission Beach Telfordville Sunnybrook Thorsby 56 3,3 3,2 278,260 395,988 139,428 197,129 138,832 Total 75+ 198,859 65-74 45-64 Total 20-44 15-19 10-14 Males 5-9 -4 1 Females < 1 Age Group Population for theCapitalHealthregion,2007 Stony Plain Sundance Beach Golden Days Highway 39 Buford Calmar St. Albert 3,4 2,6 1,061,109 526,267 534,842 6483,5 74,406 37,958 36,448 3342,8 55,365 21,981 33,384 4522,0 50,439 25,907 24,532 9973,5 61,632 31,655 29,977 3143,9 68,001 34,897 33,104 2913,2 63,405 30,424 32,981 ,2 ,8 13,613 6,888 6,725 Devon Highway 2 Edmonton Edmonton Legal

Highway 2 Bon Accord West JasperPlace Leduc Kavanagh Woodcroft Beaumont Saskatchewan Twin Brooks Twin Fort Gibbons Downs Castle

North Central North Highway 21 Cooking County Strathcona South Bonnie Doon Doon Bonnie Half MoonLake Sarepta Lake Highway 16 New Eastwood Edmonton Ardrossan Redwater Colony Hutterite Highway 14 Hwy 15 North East North Lake Cooking North Park National Elk Island A word from the Medical Officer of Health

What is a Medical Officer of Health? Unlike most to test the region’s readiness, including the physicians, who are responsible solely for the trial run of off-site pandemic triage centres health of their patients, a Medical Officer of during last year’s influenza season. Health is responsible for the health of whole G Recent increases in syphilis and mumps speak populations – the public’s health. As the Medical both to the importance of surveillance and the Officer of Health for the Capital Health region, I need to be vigilant when it comes to the oversee a wide range of programs and services health of the public. We are now participating that protect and promote the public’s health. in province-wide campaigns to control the Many of these activities take place behind the spread of these communicable diseases that scenes, where we work to ensure safe drinking many people thought were a thing of the past. water, clean air, safe housing and clean We continue to enhance our surveillance restaurants. Others take place in public health systems to provide real time information on centres, schools, community centres and private disease outbreaks. Our ability to respond homes where we screen for health problems, quickly to local outbreaks – or a global distribute vaccines and provide health pandemic – depends on an effective early information. This is the day-to-day work of public warning system. health but new challenges are always on the G Other ways in which we are meeting new horizon. Here are just a few to which we are challenges include public access to restaurant responding: inspection information that individuals can G ’s fast growing population has created access online. Starting in July 2008, we will significant public health issues, including also be involved in developing a provincial safe homelessness and the need for affordable water drinking system and an Alberta Capital housing. Our staff is involved in finding Airshed Alliance to monitor and address local solutions to homelessness with our air quality issues. community partners, and was instrumental in How healthy are we? The Annual Report of the providing safe drinking water and sanitation Medical Officer of Health is our report to you on facilities for Edmonton’s “tent city” in the the health of our population and some of the summer of 2007. key trends and factors that impact our health. G In recent years, we established the Office of New this year, we have presented health data Emergency Preparedness (OEP) to make sure by age group – babies, children and youth, we are ready in the event of a pandemic or adults and seniors – and have answered three

How healthy are we? / 2007 we? are healthy How other major public health emergency. The OEP questions for each group: Why do they go to conducts ongoing exercises and simulations the emergency department? Why do they go

1 to hospital? And why do they die? We have A word about the data….. provided health and census information in table format by the 15 public health service Capital Health region residents areas that comprise the Capital Health region. Additional data are available for the public The data used in this report are for people living in the Capital Health region. It excludes those health service areas in the document Capital people who may have received service in the Health Quick Facts, 2008. And a new report, region but reside outside the region. For Perinatal Health Status in the Capital Health example, there are many women who have their Region, 2008, has been created to provide babies in the Capital Health region but do not additional information on pregnancies and live in the region – these babies are not included births in the region. Both documents are in this report. available on the Capital Health website. Finally, we have also included a detailed Public Health Service Areas (PHS areas) section on the health implications of urban sprawl – a phenomenon that has The PHS areas for the Capital Health region are characterized much of the growth in the shown on the map on the inside front cover. region over the last several decades. The Data are provided by the 15 areas where possible. decisions we make today will not only affect our own health but will continue to be felt by Hospitalizations populations 50 years from now. We need to The term hospitalization is used to mean make the right decisions and I hope that this hospital discharge as opposed to hospital report will help decision makers in this admission. This is important when process. hospitalizations are compared across calendar years. For example, a person admitted to hospital in 2000 and discharged in 2001 will be counted among hospitalizations for 2001.

Rates and Confidence Intervals Rates (e.g. death rate, birth rate) are calculated for PHS areas as well as for the Dr. Gerry Predy region as a whole. On the charts that show Vice President, Public Health rates for each PHS area, the black dot Medical Officer of Health represents the rate while the shaded areas Capital Health, Alberta surrounding the dot display the confidence interval. The confidence interval, calculated by multiplying 1.96 times the standard error, shows that there is a 95% chance that the “true” rate will fall within the shaded area surrounding the dot.

Public health service area regions

R601 St. Albert R609 Bonnie Doon R602 Castle Downs R610 Mill Woods R603 Woodcroft R61 1 R604 Eastwood R612 Leduc County R605 North Central R613 Westview R606 North East R614 Sturgeon County R607 West R6 15 How healthy are we? / 2007 we? are healthy How R608 Twin Brooks

2 pulation data values are for June are pulation data values ile as of March 31, 2006 and 2007. ile as of March that cannot be geocoded to a public health service area but occur in the region. but occur area a public health service to that cannot be geocoded Reporting Department, Operational Policy and Integration Division, Capital Health. (3) Po and Integration Policy Department, Operational Reporting 006. (2) Health Utilization Data 2006, Clinical Accountability and 006. (2) Health Utilization Data 2006, Clinical Accountability 9.1 8.8 7.5 10.5 14.1 9.0 10.1 8.2 8.9 8.8 8.9 8.5 10.3 8.4 7.7 6.2 16.1 22.3 14.3 17.1 14.2 15.4 11.1 16.8 21.3 23.1 13.8 18.2 12.6 12.3 12.0 11.7 6.4 4.8 3.7 6.8 9.7 5.7 6.3 5.2 3.4 8.0 6.6 4.1 3.8 7.3 5.8 3.6 17.2 4.5 20.4 33.2 41.5 22.5 30.6 16.0 7.7 15.9 13.8 4.9 11.0 20.5 13.9 15.2 12.7 10.4 16.4 10.5 12.0 12.9 15.0 13.1 14.2 10.0 14.9 10.8 12.3 13.0 13.6 10.8 13.5 V V 19.7 24.0 12.6 17.1 12.4 10.3 14.6 10.1 V V 16.0 V V 48.1 40.1 58.2 39.6 47.1 51.4 54.3 48.8 53.3 38.0 53.0 41.6 48.2 51.5 50.7 41.7 10.7 11.3 12.1 11.5 10.8 9.8 9.6 9.1 8.5 11.4 10.7 13.4 12.8 10.8 10.3 16.7 77.9 79.1 78.2 76.3 72.3 77.5 76.3 79.0 80.7 77.5 78.9 79.8 80.0 77.5 76.8 78.6 22.4 17.8 V 21.0 34.8 20.3 23.0 19.0 16.7 22.0 16.0 22.2 25.6 33.7 V V 63.5 58.7 59.2 66.9 84.7 60.6 66.1 58.1 52.1 59.2 58.9 57.2 76.8 65.6 80.0 84.2 116.5 115.6 118.1 124.1 164.0 123.4 134.2 107.8 99.6 106.9 113.2 105.2 114.9 112.0 133.1 128.7 42.4 43.9 31.6 42.3 36.2 50.3 36.1 45.0 45.6 38.6 48.74 49.0 27.8 41.2 48.5 61.2 175.2 180.2 167.4 200.5 201.2 174.2 207.5 168.6 145.1 165.4 149.5 175.1 163.1 180.5 187.9 194.3 6,197 280 225 611 565 525 415 620 522 721 397 370 224 395 149 84 13,116 591 776 840 733 909 1,127 1,375 1,383 866 1,563 887 516 959 426 162 145.0 145.6 149.4 152.5 190.63 150.7 170.8 134.8 122.8 136.1 140.4 130.0 139.4 151.3 165.8 186.8 397.8 406.9 348.8 361.7 499.8 409.8 477.5 333.5 237.4 290.7 327.1 224.3 637.1 641.6 596.3 791.2 Region R601 R602 R603 R604 R605 R606 R607 R608 R609 R610 R611 R612 R613 R614 R615 How healthy are we? / 2007 we? are healthy How 30, 2006 and are interpolated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration F Plan (AHCIP) Registration Insurance the Alberta Health Care from using actual population values interpolated 2006 and are 30, Table 1: Health Statistics by Public Health Service Area, 2006 Public Health Service by 1: Health Statistics Table births Number of live Number of deaths 1,028,734Population 56,932 Crude birth rate 47,175 births per 1,000) (# live 80,030 births per (# live rate fertility General 60,877 of age) years 15-49 females 1,000 70,199 births per (# live birth rate Teen of age) years 15-19 females 1,000 75,377 105,047 women births to % Live of age and older 97,58035 years 86,664 High birth weight 104,773 births >3,999 grams) (% live 82,225 birth Preterm weeks) births < 37 41,989(% live (# deaths 73,632 mortality rate Infant of age than 1 year babies less to 31,233 births) live per 1,000 15,001 (years) females for expectancy Life males (years) for expectancy Life (per 1,000) Hospitalization rate 82.7 department visit rate Emergency (per 1,000) 84.4 (per 100,000)All cause mortality rate 84.2Ischemic heart disease death rate 606.1(per 100,000) 81.7All heart disease death rate 571.6(per 100,000) 80.1 554.7 (per 100,000) death rate Stroke (per 100,000) death rate 658.2Cancer 82.2 (per 100,000) Suicide death rate 763.9 81.9 injury death Unintentional 627.1 (per 100,000) rate 83.0 events due to areas the sum of public health service not necessarily births and deaths are for totals regional 672.2 1: The Note 84.3 586.0 530.4 83.0 573.8 82.8 592.6 83.3 573.2 84.4 553.1 82.4 631.0 641.2 81.7 641.8 82.5 Note 2: Death rates are age standardized to the 1996 Canadian population except for the infant mortality rate (IMR). mortality rate the infant for the 1996 Canadian population except to age standardized are 2: Death rates Note combined. 2002-2006 the years 2006 reflect including the IMR, for 3: Death rates, Note 2004-2006 combined. the years 2006 reflects for expectancy 4: Life Note hospitalizations. related does not include obstetric/pregnancy hospitalization rate 5: The Note high variability. due to is suppressed that the estimate 6: V indicates Note (Birth and Death data), 2002-2 Statistics (1) Vital Sources:

3 0 $83,764 0 $83,764 $82,610 $81,994 $91,980 ,762 $89,765 $93,786 $94,234 $98,096 $98,096 $94,234 $93,786 $89,765 ,762 . 1.3 0.1 1.9 1.2 4.1 3.0 1.5 1.2 1.5 0.6 2.5 0.2 0.0 0.2 0.0 0.2 17.1 4.3 30.3 14.9 24.1 27.8 20.1 18.6 26.8 10.9 33.9 4.4 2.7 2.1 2.0 2.2 18.1 20.8 13.4 19.0 16.9 8.7 9.3 20.1 34.5 30.1 15.7 17.8 9.3 9.9 7.0 10.2 2.0 2.8 1.5 2.1 2.2 1.7 1.7 1.6 1.7 3.1 1.3 1.5 2.9 1.3 3.9 2.0 5.0 2.8 4.3 8.3 9.7 5.8 7.1 5.0 2.2 3.9 3.6 2.7 3.0 7.0 7.5 3.0 0.3 0.1 0.2 0.3 0.6 0.3 0.4 0.3 0.6 0.3 0.5 0.1 0.1 0.0 0.0 0.0 21.6 15.6 22.9 22.8 27.9 31.1 27.4 20.1 13.5 16.3 21.8 17.8 25.4 25.5 25.6 19.7 16.0 12.4 16.2 21.4 24.5 19.2 22.6 17.3 12.0 17.0 17.2 10.3 11.7 11.7 11.4 14.3 27.9 24.3 18.7 45.4 43.2 25.6 22.3 27.0 22.5 33.9 15.5 20.3 28.1 21.1 18.0 34.2 96.3 96.8 96.3 96.3 93.0 94.9 96.2 96.9 96.2 95.8 95.6 98.1 97.1 98.3 96.0 97.9 Region R601 R602 R603 R604 R605 R606 R607 R608 R609 R610 R611 R612 R613 R614 R615 $46,241 $59,107 $46,290 $44,215 $40,285 $45,226 $39,280 $48,080 $49,577 $52,248 $45,138 $55,252 $45,391 $42,269 $42,598 $55,249 $42,598 $42,269 $45,391 $55,252 $45,138 $52,248 $49,577 $48,080 $39,280 $45,226 $40,285 $44,215 $46,290 $59,107 $46,241 $65,425 $83,372 $65,425 $83,372 $76,012 $51,267 * $40,674 $58,826 $68,257 $77,623 $47,984 $83,068 $65,098 $58,858 $68,248 * $67,670 1 1 How healthy are we? / 2007 we? are healthy How Table 2: Federal Census Data by Public Health Service Area, 2006 Public Health Service by Data Census 2: Federal Table alone % 65+ who live families parent % Lone % Aboriginal minorities % Visible families of census Median income families of census income Average families lone parent Female $78,424 $100,540 income average $77,268 $91,780 $61,942 $113,503 $52,241 $82,061 income $75,779 average $68,132 $64,434 $66,463 $77,015 $76,945 9 education than Grade % Less $73,347 $91,725 $95,649 $69,964 or higher % Bachelor’s degree $114,788 $76,657 $87,963 $98,67 of official Language Knowledge $83,122 $114 % English (language spoken) (language spoken) % French % English and French (language spoken) % Neither English or French ) (language spoken of age and older 15 years who are respondents or higher reflect 9 education and % Bachelor’s degree than Grade % less The Note: income. the average calculate to families insufficient numbers of male lone parent were * There BC Applications Inc., Vancouver, TETRAD Computer from software using PCensus data, calculated Census Federal Source: Male lone parent families families Male lone parent

4 Population

Figure 1: Changing age structure of the The age structure of the residents living in population, Capital Health region, 1987-2012 the Capital Health region has changed over I 1987 I 1992 I 1997 I 2002 I 2007 I 2012 the last 20 years and is expected to continue changing (Figure 1). In 1987, there were 0-14 years 184,446 198,558 184,446 children aged 0-14 years living in the 192,825 region and in 2007, the number was 193,685, 189,344 a 5% increase over 20 years. At the other end 193,685 202,461 of the age spectrum, there were 24,844 seniors aged 75 years and older living in the 15-29 years 226,579 207,552 region in 1987. By 2007, there were 55,365 189,980 seniors representing a 122% increase. 211,390 236,813 In terms of percentages, children aged 0-14 247,029 years made up about one quarter of the 30-44 years 201,247 region’s population in 1987 (22.7%). This 233,897 percentage decreased to 18.3% in 2007 and 234,730 233,785 is forecasted to decrease to 17.6% in 2012 233,580 (n=202,461). 243,813 Seniors aged 75 years and older made up 3.1% 45-59 years 108,670 125,425 of the population in 1987 whereas in 2007, this 151,388 age group accounted for 5.2% of the 191,884 population. In 2012, it is estimated that seniors 230,848 252,070 aged 75 years and older living in the Capital

60-74 years 66,078 Health region will account for 5.5% of the 78,045 population. 85,412 94,503 The population in the Capital Health region in 110,817 2007 was 1,061,109, an increase of about 140,921 32,000 from 2006. (The increase from 2005 75+ years 24,844 to 2006 was about 19,000). The average age 31,680 in the region, in 2007, was 36.8 years; down 37,039 44,960 slightly from 2006 in which it was 37.2 years. 55,365 62,847 The three largest public health service areas, in terms of population, are West Jasper Place, Source: Population data values are for June 30. Values up to March 31, 2007 are How healthy are we? / 2007 we? are healthy How interpolations of actual population values from the Alberta Health Care Insurance Mill Woods, and Twin Brooks. The smallest Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP one is Fort Saskatchewan with 15,512 people Registration File values and year-over-year population growth values provided by (Figure 2). the Health Surveillance Branch of Alberta Health and Wellness.

5 Figure 2: Population for public health service The public health service areas within the areas, Capital Health region, 2007 Capital Health region vary in the proportion of older and younger aged residents. St. Albert 57,637 In terms of percentages (Table 3), Castle Downs 49,440 G Castle Downs and Mill Woods have the Woodcroft 81,186 highest percentage of preschoolers. Eastwood 62,469 G Westview and Sturgeon County have the North Central 71,570 highest percentage of school-aged North East 78,558 children and youth.

West Jasper Place 108,574 G Eastwood has the highest percentage of adults 18-64 years of age. Twin Brooks 103,642 G North Central has the highest percentage Bonnie Doon 87,729 of young seniors (65-74 years of age). Mill Woods 109,006 G Bonnie Doon and Woodcroft have the Strathcona County 83,973 highest percentage of seniors aged 75 Leduc County 43,713 years and older. Westview 76,074 In terms of numbers (Table 4), Sturgeon County 32,026 G Mill Woods has the highest number of Fort Saskatchewan 15,512 preschoolers, school-aged children and youth, and adults (18-64 years). Source: Population data values are for June 30 and are estimated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) G Twin Brooks and West Jasper Place have Registration File as of March 31, 2007 and forecast percent population growth from June 2006 and June 2007 from the Health Surveillance Branch of Alberta the highest number of seniors 65-74 years Health and Wellness. of age. G Bonnie Doon has the highest number of seniors aged 75 years of age and older. How healthy are we? / 2007 we? are healthy How

6 Table 3: Percentage of population in selected age groups, Capital Health region, 2007 PHS Area <5 years 5-17 years 18-64 years 65-74 years 75+ years St. Albert 5.6% 18.1% 66.2% 5.9% 4.3% Castle Downs 7.6% 18.0% 65.8% 5.2% 3.4% Woodcroft 4.7% 11.1% 69.5% 6.5% 8.1% Eastwood 4.9% 11.9% 71.3% 5.6% 6.2% North Central 6.2% 17.5% 61.5% 7.9% 6.9% North East 6.8% 17.7% 66.3% 5.6% 3.6% West Jasper Place 6.0% 16.0% 65.7% 6.2% 6.1% Twin Brooks 6.3% 15.9% 65.6% 6.6% 5.6% Bonnie Doon 4.3% 11.4% 68.1% 7.0% 9.2% Mill Woods 7.3% 18.4% 67.5% 4.0% 2.8% Strathcona County 5.9% 18.5% 66.5% 5.7% 3.4% Leduc County 6.2% 18.3% 65.4% 5.6% 4.5% Westview 6.5% 19.0% 64.5% 6.1% 3.9% Sturgeon County 6.6% 21.5% 63.6% 5.0% 3.3% Fort Saskatchewan 5.8% 18.0% 65.9% 5.6% 4.7% Capital Health region 6.0% 16.4% 66.4% 6.0% 5.2%

Source: Population data values are for June 30 and are estimated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2007 and forecast percent population growth from June 2006 and June 2007 from the Health Surveillance Branch of Alberta Health and Wellness. Note: The sum of the percentages across the age groups for each public health service area may not add up to 100% due to rounding.

Table 4: Population in selected age groups, Capital Health region, 2007 PHS Area <5 years 5-17 years 18-64 years 65-74 years 75+ years St. Albert 3,228 10,431 38,133 3,379 2,466 Castle Downs 3,747 8,917 32,552 2,555 1,670 Woodcroft 3,856 9,050 56,412 5,312 6,556 Eastwood 3,070 7,441 44,561 3,522 3,875 North Central 4,432 12,554 44,024 5,638 4,923 North East 5,323 13,873 52,089 4,423 2,849 West Jasper Place 6,470 17,404 71,349 6,757 6,594 Twin Brooks 6,506 16,514 67,980 6,837 5,804 Bonnie Doon 3,804 9,964 59,776 6,141 8,044 Mill Woods 7,931 20,026 73,546 4,407 3,096 Strathcona County 4,992 15,515 55,823 4,821 2,823 Leduc County 2,725 7,986 28,586 2,466 1,950 Westview 4,947 14,486 49,042 4,669 2,930 Sturgeon County 2,118 6,875 20,361 1,614 1,058 Fort Saskatchewan 905 2,789 10,225 865 727 Capital Health region 64,052 173,826 704,461 63,405 55,365

Source: Population data values are for June 30 and are estimated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2007 and forecast percent population growth from June 2006 and June 2007 from the Health Surveillance Branch of Alberta Health and Wellness.

How healthy are we? / 2007 we? are healthy How Note: The sum of numbers across public health service areas for each age group may not add up to the Capital Health total due to rounding.

7 Health through the ages The health of Capital Health region residents is presented using four age groups: babies, children and youth, adults, and seniors. It is recognized that health is far more than health care utilization and vital statistics data (births and deaths). However, this report is based on five types of available information including: population, births, deaths, hospitalizations, and visits to the emergency department. For each age group, this information is presented with a focus on public health service areas where relevant and appropriate.

Highlights on health through the ages…

Babies Children and Youth Adults and Seniors G There was an 8.4% increase G In 2007, there were G The seniors population (75 in the number of live births 268,091 children and youth years of age and older) has from 2005 to 2006. (0-19 years) living in the increased by 122% over the G Over the last few years, Capital Health region with last 20 years. there has been a slight Mill Woods having the G Unintentional injury was increase in the general highest number (31,202). the leading reason for fertility rate although it has G For every 1,000 children visiting the emergency not yet reached the 1986 1-4 years old, 323 visited department for males and rate of 61.6 per 1,000. the emergency females 65-74 years of age. G There are fewer mothers department at least once G The most common reason smoking during pregnancy in 2006 and 24 of every adults aged 20-44 years now than five years ago. 1,000 children were were hospitalized in 2006 However, some public hospitalized. was mental disorders (for health service areas have G Unintentional injury was males) and digestive maternal prenatal smoking the number one reason for disease (for females). rates between 25-30%. children and youth G Injury, including intentional, G Half of the babies (children (5-19 years old) to visit the unintentional, and less than 1 year old) living emergency department. undetermined intent, was in the Capital Health region G For every 1,000 female the leading cause of death visited the emergency teens aged 15-19 years, for both males and females department at least once there were 16 babies born. 20-44 years old. in 2006. G The death rate for males G Cancer caused almost half G Respiratory disease was aged 15-19 years was triple of the deaths for female the most common reason the rate for females with seniors aged 65-74 years for visiting the emergency injury accounting for 70% but only about 20% of the department. of the deaths for male deaths in the older age G Almost 90% of mothers youth. group, 75 years of age and breastfeed their baby in older. the first week after birth. This percentage drops to How healthy are we? / 2007 we? are healthy How 56% by 6 months.

8 Health through the ages: Babies

Between 1992 and 1997, the number of live births be a few more years before the data show decreased from year to year in the Capital Health whether the increasing GFR is a trend. Of region. Since 2001, the percentage change has interest is that while the GFR is currently been positive with a dramatic increase in the increasing, it is still well below the rates number of babies born in 2006 to women living observed in the late eighties. in the Capital Health region (Figure 3). In 2006, The GFR varies within the region (2004 to 2006 the number of live births to women living in the data combined) (Figure 6). Public health service Capital Health region was 13,116. Mill Woods had areas with significantly higher rates than the the highest number of live births (n=1,563) and region include: Castle Downs, North East, Twin Fort Saskatchewan had the fewest (n=162) Brooks, Mill Woods, and Westview. Rates that (Figure 4). are significantly lower than the regional rate are The general fertility rate (GFR) is the number of found in St. Albert, Woodcroft, Eastwood, live births per 1,000 women between the ages Bonnie Doon and Strathcona County. of 15 and 49 years in a given year. In the Capital Health region, the GFR consistently declined from the mid 1980s until the late nineties after Figure 4: Number of live births, Capital Health which the rate slowly started to increase region residents, 2006 (Figure 5). In 2006, the GFR was 48.1 but it will St. Albert 591

Castle Downs 776

Woodcroft 840 Figure 3: Percentage change from one year to the next in the number of live births, Eastwood 733 Capital Health region, 1997-2006 North Central 909

-5.5 1997 North East 1,127

1998 3.4 West Jasper Place 1,375

1999 1.2 Twin Brooks 1,383

-4.7 2000 Bonnie Doon 866

2001 2.5 Mill Woods 1,563

2002 2.2 Strathcona County 887

2003 3.6 Leduc County 516

2004 1.9 Westview 959

How healthy are we? / 2007 we? are healthy How 2005 1.6 Sturgeon County 426

2006 8.4 Fort Saskatchewan 162

Source: Vital Statistics (Birth Data) 1997-2006. Source: Vital Statistics (Birth Data) 2006.

9 Figure 5: General fertility rate, Figure 6: General fertility rate by PHS area, Capital Health region, 1986-2006 Capital Health region, 2004-2006 combined Number of births per 1,000 women 15-49 years of age Number of births per 1,000 women 15-49 years of age 1986 • 61.6 Capital Health region • 46.0

1987 • 58.1 St. Albert • 40.2

1988 • 58.9 Castle Downs • 54.6

1989 • 58.8 Woodcroft • 39.5

1990 • 58.4 Eastwood • 43.1

1991 • 57.9 North Central • 48.2

1992 • 55.0 North East • 49.9

1993 • 52.5 West Jasper Place • 46.2

1994 • 50.6 Twin Brooks • 49.9

1995 • 48.9 Bonnie Doon • 36.6

1996 • 47.0 Mill Woods • 52.1

1997 • 44.2 Strathcona County • 42.1

1998 • 45.3 Leduc County • 46.4

1999 • 45.0 Westview • 50.0

2000 • 42.5 Sturgeon County • 47.5

2001 • 42.9 Fort Saskatchewan • 44.4

2002 • 43.2 Sources: (1) Vital Statistics (Birth Data) 2004-2006. (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population 2003 • 44.2 values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are 2004 • 44.7 estimated using the March 31, 2007 AHCIP Registration File values and year-over- year population growth values provided by the Health Surveillance Branch of 2005 • 45.2 Alberta Health and Wellness.

2006 • 48.1 For the combined years 2002 to 2006, there were Sources: (1) Vital Statistics (Birth Data) 1986-2006. (2) Population data values are for 400 singleton babies born (as opposed to a June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of multiple birth like twins or triplets) who were both March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over- small-for-gestational age and preterm accounting year population growth values provided by the Health Surveillance Branch of for 8.8% of all singleton, preterm babies; and less Alberta Health and Wellness. than 1% of all singleton, live births (Figure 7). In Alberta, there were 311 singleton, SGA/Preterm babies born in 2005 representing 10.2% of all There are a number of birth outcomes that singleton, preterm births; and less than 1% of all are important to look at when assessing the singleton live births. health status of babies in the region including preterm birth (babies born earlier than 37 Non-modifiable predictors of SGA/Preterm weeks) and small-for-gestational age (babies babies are:1 who have a birth weight below the 10th G induced labour percentile of appropriate weight for G congenital anomalies gestational age babies). G cesarean section Small-for-Gestational Age (SGA)/ G previous maternal history of infant death. Preterm Births (PTB) Modifiable predictors of SGA/Preterm babies are1: These babies have the double disadvantage G maternal prenatal smoking of being born too early, earlier than 37 G maternal age of 35 years and older How healthy are we? / 2007 we? are healthy How weeks, as well as the possibility of being growth restricted in utero, resulting in a high In addition, women who attended prenatal classes likelihood of infant disease and death. were less likely to have a SGA/Preterm baby.1

10 1 Twilley, L. & Wang, F-L. (2007). Predictors of Preterm and Small-for-Gestational-Age in Alberta. Edmonton, AB: Alberta Health and Wellness. Figure 7: Small-for-gestational age and preterm Figure 8: Maternal prenatal smoking rate, birth, Capital Health region, 1993-97 to 2002-06 Capital Health region, 1999-2005 Rate per 100 singleton live births Rate per 100 singleton live births N SGA/PTB I SGA/Term G Not SGA/PTB 1999 G 23.4 9 2000 G 22.2 G 8 2001 21.7 2002 G 20.3 7 2003 G 18.2 6 2004 G 17.9 5 2005 G 17.2

Source: Alberta Perinatal Health Program, Provincial Data Repository 4

3 Figure 9: Maternal prenatal smoking rate 2 by age group, Capital Health region, 1999-2005 combined 1 Rate per 100 singleton live births <20 years G 46.9 0 20-24 years G 32.9 25-29 years G 15.3 30-34 yearsG 10.1

1993-1997 1994-1998 1995-1999 1996-2000 1997-2001 1998-2002 1999-2003 2000-2004 2001-2005 2002-2006 35-39 yearsG 10.6 Sources: Vital Statistics (Birth Data) 1993-2006. 40+ years G 11.2

Source: Alberta Perinatal Health Program, Provincial Data Repository Small-for-Gestational Age (SGA)/ Term Births In a recent report,1 preterm delivery was These babies are likely growth restricted in associated with maternal pre-existing medical utero but are not born earlier than 37 weeks. conditions, past history of preterm birth, SGA For the five year period between 2002 and birth, or neonatal death, and pregnancy 2006, there were 3,802 singleton SGA/Term complications. Modifiable factors associated babies born in the Capital Health region, with preterm birth accounted for only 11% of representing 7.1% of all singleton, term births the overall preterm birth risk and included and 6.5% of all singleton live births. There is a maternal age of 35 years of age and older, decreasing trend in the rate of SGA/Term births maternal prenatal smoking and street drug use. in the region (Figure 7). In Alberta, 7.7% of all singleton, term births are small-for-gestational Prenatal Smoking age and 7.1% of all singleton live births are SGA. One of the modifiable risk factors for SGA/Preterm babies is maternal prenatal Not Small-for-Gestational Age smoking. Since 1999, the percentage of women (SGA)/Preterm Births (PTB) who reported smoking during pregnancy While these babies are not small-for- decreased from 23.4% in 1999 to 17.2% in 2005 gestational age, they are born earlier than 37 (Figure 8). While this is a promising trend for weeks gestation. For the five year period the region, there are substantial differences in between 2002 and 2006, there were 4,125 the maternal prenatal smoking rate between singleton Not SGA/PTB babies born in the public health service areas and between Capital Health region representing 91.2% of maternal age groups.

How healthy are we? / 2007 we? are healthy How all singleton, preterm births and 7.1% of all The maternal smoking rate was much higher in singleton live births. Over the years, this rate the younger age groups than the older age has shown a slight increase (Figure 7). groups (Figure 9). Almost half of the pregnant,

11 1 Twilley, L. & Wang, F-L. (2007). Predictors of Preterm and Small-for-Gestational-Age in Alberta. Edmonton, AB: Alberta Health and Wellness. Figure 10: Maternal prenatal smoking rate by Figure 11: Age specific fertility rates, PHS area, Capital Health region, 2003-2005 Capital Health region, 1997-2006 combined Rate per 100,000 population Rate per 100 live births L 13-17 years N 25-29 years M 40-49 years Capital Health region • 17.7 G 18-19 years I 30-34 years I 20-24 years G 35-39 years St. Albert • 9.5 120 Castle Downs • 15.9

Woodcroft • 24.9 100

Eastwood • 30.4 80 North Central • 19.6

North East • 26.3 60 West Jasper Place • 16.4 Twin Brooks • 8.6 40 Bonnie Doon • 14.7 20 Mill Woods • 15.6

Strathcona County • 11.1 0 Leduc County • 20.4

Westview • 20.0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Sturgeon County • 23.0 Sources: (1) Vital Statistics (Birth Data), 1997-2006. (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population Fort Saskatchewan • 18.5 values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are Source: Alberta Perinatal Health Program, Provincial Data Repository estimated using the March 31, 2007 AHCIP Registration File values and year-over- year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness.

young women, under 20 years of age, reported smoking at some time during their pregnancy. 1997, 13.9% of live births were to women 35 years The rate decreased to a low of 10.1% for women of age and older, in 2006, 16.1% of live births were aged 30-34 years. to women of this age. The percentage of pregnant women who The age-specific fertility rates for women 35 reported smoking varied substantially within years of age and older, by public health service the Capital Health region ranging from a high of area (Figure 12), show that Twin Brooks and St. 30.4% in Eastwood to a low of 8.6% in Twin Albert have the highest fertility rates among Brooks (Figure 10). The regional rate for 2003- women 35-39 years of age, while Castle Downs, 2005 was 17.7%. Twin Brooks, and Bonnie Doon have the highest fertility rates for women 40-49 years of age. Maternal Age Maternal age (women aged 35 years and older) Why do babies go to the emergency is identified as one of the modifiable predictors department (ED)? for SGA/Preterm babies. The age-specific In 2006, there were almost 10,000 visits made to fertility rate is the number of live births per the emergency department for children less than 1,000 women in a given age group in a given 1 year of age (females=4,534 and males=5,459). year (Figure 11). There has been a slow increase Babies living in the Capital Health region are in the fertility rate among women aged 35-39 going to the emergency department most often years in the region increasing from 31.3 per for respiratory disease with acute upper 1,000 women 35-39 years in 1997 to 47.9 per respiratory infection accounting for 43% of 1,000 women in 2006. respiratory related visits. Acute bronchiolitis and

How healthy are we? / 2007 we? are healthy How The percent of live births born to women 35 acute obstructive laryngitis (commonly known as years of age and older has significantly increased croup) were also major contributors to in the region over the last 10 years. Whereas in respiratory related ED visits (Table 5).

12 Figure 12: Number of live births by PHS area When the emergency department visit rate is and selected age groups, Capital Health region, calculated to reflect the number of individuals 2004-2006 combined as opposed to the number of visits (as it is Rate per 1,000 women shown in Table 5), the ED visit rate for children 35-39 years 40-49 years less than 1 year of age was 491.9 per 1,000 population in 2006 (males=516.6 per 1,000; Capital Health region 43.5 3.8 females=465.8 per 1,000). This means that St. Albert 53.8 2.9 almost half of children less than 1 year of age Castle Downs 42.3 5.0 visited the emergency department at least once in 2006. Among the children who went to Woodcroft 39.7 3.5 the emergency department in 2006, the Eastwood 37.7 4.5 average number of visits was 1.6 for both males North Central 36.7 2.9 and females. North East 35.1 3.7 Emergency Department (ED) visits by PHS area West Jasper Place 48.0 4.2 The ED visit rate for children less than 1 year old living in the region was 824.5 per 1,000 population Twin Brooks 62.3 5.4 for 2004-2006 (Figure 13). The ED visit rate for Bonnie Doon 48.2 5.4 this age was highest in Fort Saskatchewan, Mill Woods 43.2 4.1 Westview, Leduc County, and Sturgeon County. The lowest rates were found in Twin Brooks, Strathcona County 42.3 3.1 Bonnie Doon, and Strathcona County. Leduc County 36.0 2.7 Westview 36.4 3.2 Figure 13: Emergency department visit rate for Sturgeon County 34.2 1.4 children less than 1 year old by PHS area, Fort Saskatchewan 28.2 1.1 Capital Health region, 2004-2006 combined

Sources: (1) Vital Statistics (Birth Data), 2004-2006. (2) Population data values are Rate per 1,000 for June 30. Values up to March 31, 2007 are interpolations of actual population Capital Health region 824.5 values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are 805.9 estimated using the March 31, 2007 AHCIP Registration File values and year-over- St. Albert year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness. Castle Downs 755.7 Woodcroft 738.6

Eastwood 924.4 Table 5: Emergency department (ED) visits for males and females less than 1 year old, North Central 908.4 Capital Health region, 2006 North East 1,112.8 Leading causes by percent and (rank) West Jasper Place 698.2 Males Females Cause % (rank) % (rank) Twin Brooks 568.9 Respiratory disease 30.1% (1) 26.8% (1) Bonnie Doon 555.5

Digestive disease 13.1% (2) 14.0% (2) Mill Woods 707.5

Infectious/parasitic diseases 7.9% (3) 8.1% (4) Strathcona County 440.7

Unintentional injury 6.7% (4) 8.4% (3) Leduc County 1,182.8

Nervous system disease 5.4% (5) 5.0% (5) Westview 1,257.8

Males Females Sturgeon County 1,162.5

Number of ED visits 5,459 4,534 Fort Saskatchewan 1,865.2

Population (2006) 6,517 6,086 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). ED visit rate per 1,000 850.7 745.0 (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance

How healthy are we? / 2007 we? are healthy How Sources: (1) Clinical Accountability and Reporting Department, Operational Policy Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for and Integration Division, Capital Health (Health Care Utilization Data 2006). points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP (2) Population data values are for June 30, 2006 and are interpolated using actual Registration File values and year-over-year population growth values provided by population values from the Alberta Health Care Insurance Plan (AHCIP) the Health Surveillance Branch of Alberta Health and Wellness. Registration File as of March 31, 2006 and 2007. Note: Confidence intervals are not displayed due to rates higher than 1,000 per 1,000.

13 Please note that the higher ED visit rates in jaundice (11%); and respiratory conditions (e.g. the more rural areas of the region including respiratory distress syndrome) (14%). Leduc County, Westview, Sturgeon County When the hospitalization rate is calculated to and Fort Saskatchewan may reflect fewer reflect the number of individuals as opposed options for the residents living in these areas to the number of hospitalizations (as it is for treatment outside of regular office hours. shown in Table 6), the hospitalization rate for children less than 1 year of age was 267.1 per Why do babies go to the hospital? 1,000 population in 2006 (males=288.8 per In 2006, there were just over 4,100 1,000; females=244.2 per 1,000). Among the hospitalizations for children less than 1 year of children who were hospitalized in 2006, the age (females=1,830 and males=2,306). When average number of hospitalizations was 1.2 birth events are included, the total number of for both males and females. hospitalizations in 2006 for this age group was Hospitalizations by PHS area 14,826. Babies living in the Capital Health region There were 342.6 hospitalizations for every are hospitalized most often for conditions 1,000 children less than 1 year of age in the originating in the perinatal period (Table 6). The Capital Health region in 2004-2006 (Figure 14). perinatal period generally means the period There was variation in the hospitalization rate immediately before and after birth. It is defined within the region. Woodcroft (392.8 per 1,000) as starting any time between week 20 and 28 of gestation and ending between week 1 and 4 after birth. Figure 14: Hospitalization rate for children Of these conditions originating in the perinatal less than 1 year old by PHS area, period, the ones that required hospitalization Capital Health region, 2004-2006 combined most often were disorders related to short Rate per 1,000 gestation and low birth weight (35%); neonatal Capital Health region • 342.6

St. Albert • 274.6

Castle Downs • 283.7

Table 6: Hospitalization for males and females Woodcroft • 392.8 less than 1 year old, Capital Health region, 2006 Eastwood • 452.0 Leading causes by percent and (rank) Males Females North Central • 322.9 Cause % (rank) % (rank) North East • 349.8 Perinatal conditions 67.8% (1) 69.1% (1) West Jasper Place • 337.5 Respiratory disease 8.2% (2) 6.8% (3) Twin Brooks • 332.8 Congenital anomalies 7.9% (3) 7.8% (2) Bonnie Doon • 351.1 Digestive disease 4.0% (4) 2.3% (4) Mill Woods • 361.5 Genitourinary disease 1.4% (5) 1.2% Strathcona County • 315.0 Infectious/parasitic diseases 1.1% 1.7% (5) Leduc County • 318.5 Males Females Westview • 315.7 Number of hospitalalizations (including births) 7,687 7,139 Sturgeon County • 335.6 Number of hospitalizations Fort Saskatchewan • 340.6

(excluding births) 2,306 1,830 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). Population (2006) 6,417 6,086 (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Hospitalization rate per 1,000 Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for (excluding births) 359.4 300.7 points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over-year population growth values provided by

How healthy are we? / 2007 we? are healthy How Sources: (1) Clinical Accountability and Reporting Department, Operational Policy the Health Surveillance Branch of Alberta Health and Wellness. and Integration Division, Capital Health (Health Care Utilization Data 2006). Note: Birth events were excluded from the hospitalization rate unless the most (2) Population data values are for June 30, 2006 and are interpolated using actual responsible diagnosis at time of discharge was not the birth event (e.g., the baby population values from the Alberta Health Care Insurance Plan (AHCIP) stayed in hospital for reasons such as congenital anomalies, or conditions related to Registration File as of March 31, 2006 and 2007. the perinatal period).

14 Figure 15: Infant mortality rate, Figure 16: Infant mortality rate by PHS area, Capital Health region, 1996-2000 to 2002-2006 Capital Health region, 1997-2006 combined (5 years combined) Rate per 1,000 live births Rate per 1,000 live births Capital Health region • 6.2

1996-2000 • 5.7 St. Albert • 5.5

1997-2001 • 6.0 Castle Downs • 4.5

1998-2002 • 5.8 Woodcroft • 5.7

1999-2003 • 6.2 Eastwood • 10.5

2000-2004 • 6.5 North Central • 5.3

2001-2005 • 6.5 North East • 6.5

2002-2006 • 6.4 West Jasper Place • 6.0 Source: Vital Statistics (Birth and Death Data), 1996-2006. Twin Brooks • 3.3

Bonnie Doon • 7.4

Mill Woods • 5.7 and Eastwood (452.0 per 1,000) Public Health Strathcona County • 4.8 Service areas had the highest rates and they were both significantly higher than the regional Leduc County • 4.8 rate. Conversely, St. Albert at 274.6 per 1,000 Westview • 6.4 and Castle Downs at 283.7 per 1,000 were the Sturgeon County • 3.8 public health service areas with the lowest Fort Saskatchewan • 3.6 rates; they were significantly lower than the Source: Vital Statistics (Birth and Death Data), 1997-2006. regional rate of 342.6 per 1,000 children less than 1 year old.

Why do babies die? Breastfeeding In 2006, there were 77 babies who died Breast milk is the best milk for babies for a before their first birthday. While the number of reasons including: increasing trend in the infant mortality rate in G it is easily digested the region, from 5.7 deaths per 1,000 live G it helps protect babies from infection and births in 1996-2000 to 6.4 in 2002-2006, is illness not statistically significant, it is a trend that G it may help prevent allergies continues to be monitored (Figure 15). Over G three quarters of the infant deaths occurring it is always fresh and exactly the right temperature in the five year period 2002-2006 were due to congenital anomalies and conditions G it changes to meet a baby’s growing needs arising in the perinatal period. In, 2006, there was a relatively high Eastwood Public Health Service area had an percentage (from 80% to 93%) of mothers who breastfed their baby during the first infant mortality rate that was significantly week after the birth (Figure 17). At the 4-<6 higher than the region, while Twin Brooks at month mark, the percentage of moms 3.3 deaths per 1,000 live births was breastfeeding their babies decreased to 56% significantly lower (Figure 16). with a high of 71% in Twin Brooks to less than half in Eastwood, North East, Sturgeon County and Fort Saskatchewan. How healthy are we? / 2007 we? are healthy How

15 Figure 17: Percentage of mothers breastfeeding by PHS area, Capital Health region, 2006 I 2-7 days I 4-<6 months Capital Health region 88 56

St. Albert 91 58

Castle Downs 87 53

Woodcroft 87 57

Eastwood 83 45

North Central 84 52

North East 80 46

West Jasper Place 88 56

Twin Brooks 93 71

Bonnie Doon 91 67

Mill Woods 88 55

Strathcona County 90 61

Leduc County 86 51

Westview 83 55

Sturgeon County 88 43

Fort Saskatchewan 81 45

Source: Capital Health, Community Health Services, 2006. Note: Breastfeeding is defined as “any breastfeeding” including those babies who are breastfed exclusively, partially, or predominantly. How healthy are we? / 2007 we? are healthy How

16 Health through the ages: Children and Youth

The number, and percentage, of children and G Sturgeon County has the highest percentage youth in the region varies by public health service of children/youth among the PHS areas area (PHS area). (Figure 18 and Table 7) (31.5%) although it has one of the lowest G In the region, 25.3% of the population is numbers (10,092). made up of children/youth 0-19 years of age. G Mill Woods has the highest number of children/youth (31,202).

Figure 18: Number of children by age group and PHS area, Capital Health region, 2007 I < 1 year I 1-4 years I 5-9 years I 10-14 years I 15-19 years St. Albert Castle Downs Woodcroft Eastwood North Central North East West Jasper Place Twin Brooks Bonnie Doon Mill Woods Strathcona County Leduc County Westview Sturgeon County Fort Saskatchewan

0 10,000 20,000 30,000

Source: Population data values are for June 30 and are estimated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2007 and forecast percent population growth from June 2006 and June 2007 from the Health Surveillance Branch of Alberta Health and Wellness. How healthy are we? / 2007 we? are healthy How

17 Table 7: Number (percentage) of children in selected age groups by PHS area, Capital Health region, 2007 PHS Area <1 year 1-4 years 5-9 years 10-14 years 15-19 years 0-19 years St. Albert 604 (1.0) 2,624 (4.6) 3,520 (6.1) 4,184 (7.3) 4,622 (8.0) 15,554 (27.0) Castle Downs 823 (1.7) 2,923 (5.9) 3,323 (6.7) 3,485 (7.0) 3,507 (7.1) 14,061 (28.4) Woodcroft 903 (1.1) 2,953 (3.6) 3,245 (4.0) 3,523 (4.3) 3,979 (4.9) 14,603 (18.0) Eastwood 760 (1.2) 2,310 (3.7) 2,603 (4.2) 2,971 (4.8) 3,304 (5.3) 11,948 (19.1) North Central 931 (1.3) 3,501 (4.9) 4,498 (6.3) 4,916 (6.9) 5,248 (7.3) 19,094 (26.7) North East 1,171 (1.5) 4,152 (5.3) 5,082 (6.5) 5,416 (6.9) 5,687 (7.2) 21,507 (27.4) West Jasper Place 1,392 (1.3) 5,077 (4.7) 5,987 (5.5) 6,816 (6.3) 7,837 (7.2) 27,110 (25.0) Twin Brooks 1,428 (1.4) 5,079 (4.9) 6,007 (5.8) 6,315 (6.1) 7,092 (6.8) 25,921 (25.0) Bonnie Doon 922 (1.1) 2,882 (3.3) 3,430 (3.9) 3,925 (4.5) 4,619 (5.3) 15,779 (18.0) Mill Woods 1,647 (1.5) 6,284 (5.8) 7,430 (6.8) 7,759 (7.1) 8,083 (7.4) 31,202 (28.6) Strathcona County 914 (1.1) 4,077 (4.9) 5,353 (6.4) 6,098 (7.3) 6,743 (8.0) 23,186 (27.6) Leduc County 517 (1.2) 2,208 (5.1) 2,812 (6.4) 3,117 (7.1) 3,451 (7.9) 12,105 (27.7) Westview 993 (1.3) 3,954 (5.2) 5,055 (6.6) 5,624 (7.4) 6,106 (8.0) 21,731 (28.6) Sturgeon County 435 (1.4) 1,683 (5.3) 2,343 (7.3) 2,755 (8.6) 2,876 (9.0) 10,092 (31.5) Fort Saskatchewan 172 (1.1) 733 (4.7) 944 (6.1) 1,097 (7.1) 1,251 (8.1) 4,197 (27.1) Capital Health 13,613 (1.3) 50,439 (4.8) 61,632 (5.8) 68,001 (6.4) 74,405 (7.0) 268,091 (25.3)

Source: Population data values are for June 30 and are estimated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2007 and forecast percent population growth from June 2006 and June 2007 from the Health Surveillance Branch of Alberta Health and Wellness.

Why do children and youth go to the to the emergency department in 2006, the emergency department (ED)? average number of visits was 1.6 for males and 1.5 for females. 1-4 YEAR OLDS In 2006, there were 24,521 visits made to the emergency department (ED) resulting in an ED Table 8: Emergency department (ED) visits for males and females 1-4 years old, visit rate of 508.3 for every 1,000 children aged Capital Health region, 2006 1-4 years living in the Capital Health region (Table 8). Respiratory disease was the leading Leading causes by percent and (rank) cause for visiting the emergency department Males Females Cause % (rank) % (rank) for both boys and girls with the most frequent Respiratory disease 27.4% (1) 24.2% (1) reasons being: acute upper respiratory infection, acute obstructive laryngitis (croup), Unintentional injury 23.5% (2) 22.9% (2) asthma, and pneumonia. These four diseases Digestive disease 9.7% (3) 10.3% (4) accounted for 75% of the respiratory related Nervous system disease 6.7% (4) 10.9% (3) visits to the emergency department. Infectious/parasitic diseases 6.4% (5) 6.6% (5) When the emergency department visit rate is calculated to reflect the number of individuals Males Females as opposed to the number of visits (as it is Number of ED visits 13,810 10,711 shown in Table 8), the ED visit rate for children Population (2006) 24,734 23,503 aged 1-4 years was 323.9 per 1,000 population in 2006 (males=349.4 per 1,000; ED visit rate per 1,000 558.3 455.7 females=297.2 per 1,000). This means that Sources: (1) Clinical Accountability and Reporting Department, Operational Policy

How healthy are we? / 2007 we? are healthy How and Integration Division, Capital Health (Health Care Utilization Data 2006). about one third of children 1-4 years of age (2) Population data values are for June 30, 2006 and are interpolated using actual visited the emergency department at least population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2006 and 2007. once in 2006. Among the children who went

18 Emergency department (ED) visits by PHS area group. Of the unintentional injury-related ED For every 1,000 young children 1-4 years old visits, 40% were due to falls (including sports living in the Capital Health region, there were related falls). 526.1 visits made to the emergency department When the emergency department visit rate is for 2004-2006 combined (Figure 19). There calculated to reflect the number of individuals was variation in the emergency department as opposed to the number of visits (as it is visit rate among the public health service areas shown in Table 9), the ED visit rate for children with the more rural areas of the region having 5-9 years old was 179.9 per 1,000 population in the highest rates. 2006 (males=193.9.0 per 1,000; females=165.0 per 1,000). Among the children who went to 5-9 YEAR OLDS the emergency department in 2006, the In 2006, there were about 15,300 visits made to average number of visits was 1.4 for both males the emergency department (ED) resulting in an and females. ED visit rate of 252.8 for every 1,000 children Emergency department (ED) visits by PHS area aged 5-9 years living in the Capital Health As was the case with younger children, there region (Table 9). was variation in the emergency department While respiratory disease was the leading cause visit rate among the public health service areas for visiting the emergency department in with the more rural areas having higher rates younger children, unintentional injury was the (Figure 20). leading cause of emergency department visits for both boys and girls in the 5-9 year age 10-14 YEAR OLDS In 2006, there were 17,944 visits made to the emergency department (ED) by children and Figure 19: Emergency department visits for youth aged 10-14 years old (Table 10). Males children 1-4 years old by PHS area, had a slightly higher ED visit rate than females – Capital Health region, 2004-2006 combined 283 visits per 1,000 compared to 245 per 1,000. Rate per 1,000 Unintentional injury was the leading cause of Capital Health region • 526.1 emergency department visits for both males St. Albert • 608.0 and females followed by respiratory disease.

Castle Downs • 482.2 Of the unintentional injury-related visits, 60%

Woodcroft • 442.0

Eastwood • 431.5 Table 9: Emergency department (ED) visits for males and females 5-9 years old, North Central • 526.4 Capital Health region, 2006 North East • 617.0 Leading causes by percent and (rank) West Jasper Place • 459.6 Males Females Cause % (rank) % (rank) Twin Brooks • 374.8 Unintentional injury 29.9% (1) 29.6% (1) Bonnie Doon • 410.1 Respiratory disease 22.8% (2) 19.9% (2) Mill Woods • 437.1 Nervous system disease 8.2% (3) 8.5% (3) Strathcona County • 273.4 Digestive disease 6.8% (4) 5.8% (4) Leduc County • 866.3 Infectious/parasitic diseases 4.5% (5) 4.5% (5) Westview • 889.3 Males Females Sturgeon County • 744.6 Number of ED visits 8,526 6,818 Fort Saskatchewan 1,075.4 Population (2006) 31,273 29,434 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). ED visit rate per 1,000 272.6 231.6 (2) Population data values are for June 30. Values up to March 31, 2007 are

How healthy are we? / 2007 we? are healthy How interpolations of actual population values from the Alberta Health Care Insurance Sources: (1) Clinical Accountability and Reporting Department, Operational Policy Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for and Integration Division, Capital Health (Health Care Utilization Data 2006). points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP (2) Population data values are for June 30, 2006 and are interpolated using actual Registration File values and year-over-year population growth values provided by population values from the Alberta Health Care Insurance Plan (AHCIP) the Health Surveillance Branch of Alberta Health and Wellness. Registration File as of March 31, 2006 and 2007.

19 Figure 20: Emergency department visits for Table 10: Emergency department (ED) visits for children 5-9 years old by PHS area, males and females 10-14 years old, Capital Health region, 2004-2006 combined Capital Health region, 2006 Rate per 1,000 Leading causes by percent and (rank) Capital Health region • 262.6 Males Females Cause % (rank) % (rank) St. Albert • 314.6 Unintentional injury 50.9% (1) 41.7% (1) Castle Downs • 222.7 Respiratory disease 9.9% (2) 11.6% (2) Woodcroft • 185.2 Nervous system disease 4.0% (3) 4.8% (3) Eastwood • 196.6 Digestive disease 3.9% (4) 4.5% (4) North Central • 263.1 Musculoskeletal/connective North East • 278.8 tissue diseases 2.5% (5) 2.6% West Jasper Place• 213.2 Mental disorders 1.7% 3.1% (5) Twin Brooks • 171.6 Males Females Bonnie Doon • 173.7 Number of ED visits 9,790 8,154 Mill Woods • 211.7 Population (2006) 34,623 33,260 Strathcona County• 128.4 ED visit rate per 1,000 282.8 245.2

Leduc County • 496.8 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2006). Westview • 499.4 (2) Population data values are for June 30, 2006 and are interpolated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Sturgeon County • 425.8 Registration File as of March 31, 2006 and 2007.

Fort Saskatchewan • 529.5

Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for Table 11: Emergency department (ED) visits for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP males and females 15-19 years old, Registration File values and year-over-year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness. Capital Health region, 2006 Leading causes by percent and (rank) were caused by falls (including sports related Males Females Cause % (rank) % (rank) falls) and injuries caused by being struck by an object or person (also including sports). Unintentional injury 45.1% (1) 24.3% (1) When the emergency department visit rate is Respiratory disease 7.4% (2) 9.9% (2) calculated to reflect the number of individuals Intentional injury 6.7% (3) 3.3% as opposed to the number of visits (as it is Mental disorders 4.7% (4) 5.3% (5) shown in Table 10), the ED visit rate for children/youth aged 10-14 years was 179.5 per Digestive disease 4.0% (5) 5.8% (4) 1,000 population in 2006 (males=192.9 per Genitourinary disease 1.1% 6.9% (3) 1,000; females=165.6 per 1,000). Among the Males Females children/youth who went to the emergency Number of ED visits 15,115 15,041 department in 2006, the average number of visits was 1.5 for both males and females. Population (2006) 37,216 35,779 Emergency department (ED) visits by PHS area ED visit rate per 1,000 406.1 420.4 With the exclusion of Strathcona County, the Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2006). rural areas had significantly higher emergency (2) Population data values are for June 30, 2006 and are interpolated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) department visit rates than the region (Figure Registration File as of March 31, 2006 and 2007. 21). The only urban public health service area

How healthy are we? / 2007 we? are healthy How that had a significantly higher rate than the regional rate was St. Albert.

20 Figure 21: Emergency department visits for Figure 22: Emergency department visits for children 10-14 years old by PHS area, children 15-19 years old by PHS area, Capital Health region, 2004-2006 combined Capital Health region, 2004-2006 combined Rate per 1,000 Rate per 1,000 Capital Health region • 274.6 Capital Health region • 410.2

St. Albert • 357.5 St. Albert • 427.9

Castle Downs • 210.9 Castle Downs • 326.4

Woodcroft • 197.3 Woodcroft • 442.8

Eastwood • 199.4 Eastwood • 462.7

North Central • 241.6 North Central • 375.1

North East • 281.3 North East • 433.5

West Jasper Place • 227.4 West Jasper Place • 349.1

Twin Brooks • 161.3 Twin Brooks • 218.5

Bonnie Doon • 177.3 Bonnie Doon • 330.0

Mill Woods • 221.2 Mill Woods • 306.7

Strathcona County• 128.5 Strathcona County• 205.7

Leduc County • 532.3 Leduc County • 752.9

Westview • 519.2 Westview • 714.7

Sturgeon County • 482.2 Sturgeon County • 574.1

Fort Saskatchewan • 603.1 Fort Saskatchewan • 845.7

Sources: (1) Clinical Accountability and Reporting Department, Operational Policy Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). (2) Population data values are for June 30. Values up to March 31, 2007 are (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over-year population growth values provided by Registration File values and year-over-year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness. the Health Surveillance Branch of Alberta Health and Wellness.

15-19 YEAR OLDS between 15 and 19 years of age was 252.5 per In this age group, the females had a higher rate 1,000 population in 2006 (males=255.0 per than the males at 420.4 visits per 1,000 1,000; females=249.9 per 1,000). Among the population aged 15-19 years compared to 406.1 youth who went to the emergency department per 1,000 (Table 11). Once again, unintentional in 2006, the average number of visits was 1.6 injury was the leading cause of emergency for males and 1.7 for females. department visits for both males and females. Emergency department (ED) visits by PHS area For males, unintentional injury accounted for 45% Higher rates than the regional rate of 410.2 per of the visits made to the emergency department. 1,000 youth aged 15-19 years were observed in Being struck by an object or person (including the more rural areas of Leduc County, sports) and falls (including sports related falls) Westview, Sturgeon County and Fort were two of the major contributors to Saskatchewan (Figure 22). unintentional injury-related visits to the emergency department. Intentional injury ranked third for males and of the 1,007 intentional injury- related ED visits, 86.4% were due to assault and another 11.4% were due to self-inflicted injury. When the emergency department visit rate is How healthy are we? / 2007 we? are healthy How calculated to reflect the number of individuals as opposed to the number of visits (as it is shown in Table 11), the ED visit rate for youth

21 Table 12: Hospitalizations for males and females Figure 23: Hospitalizations for children 1-4 years old, Capital Health region, 2006 1-4 years old by PHS area, Capital Health region, Leading causes by percent and (rank) 2004-2006 combined Males Females Rate per 1,000 Cause % (rank) % (rank) Capital Health region • 30.9 Respiratory disease 36.0% (1) 35.0% (1) St. Albert • 28.3 Unintentional injury 9.8% (2) 8.8% (2) Castle Downs • 38.9 Nervous system disease 8.8% (3) 8.3% (3) Woodcroft • 28.5 Digestive disease 8.5% (4) 7.0% (4) Eastwood • 24.1 Congenital anomalies 7.6% (5) 5.3% North Central • 28.1 Infectious/parasitic diseases 5.0% 5.9% (5) North East • 30.0 Males Females West Jasper Place • 28.9 Number of hospitalizations 838 589 Twin Brooks • 27.7 Population (2006) 24,734 23,503 Bonnie Doon • 32.7 Hospitalization rate per 1,000 33.9 25.1 Mill Woods • 36.9 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2006). Strathcona County • 33.7 (2) Population data values are for June 30, 2006 and are interpolated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Leduc County • 29.1 Registration File as of March 31, 2006 and 2007. Westview • 25.8

Sturgeon County • 31.9

Fort Saskatchewan • 44.9 Why do children and youth Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). go to the hospital? (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for 1-4 YEAR OLDS points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over-year population growth values provided by In 2006, there were 29.6 hospitalizations for the Health Surveillance Branch of Alberta Health and Wellness. every 1,000 children aged 1-4 years living in the Capital Health region with boys having a higher hospitalization rate than girls (33.9 per 1,000 Hospitalizations by PHS area versus 25.1 per 1,000) (Table 12). Although the hospitalization rates ranged from a Respiratory disease was the leading cause of low of 24.1 per 1000 in Eastwood to a high of 44.9 hospitalization for both boys and girls. The most in Fort Saskatchewan, there was no significant frequent respiratory-related hospitalizations variation in the hospitalization rate within the were for asthma (25.8%), tonsils/adenoids region for children aged 1-4 years (Figure 23). (13.2%), acute bronchiolitis (11.2%), and pneumonia (11.0%). Together, they accounted for 5-9 YEAR OLDS just over 60% of the respiratory-related In 2006, there were 17.1 hospitalizations for every hospitalizations. 1,000 children aged 5-9 years living in the Capital When the hospitalization rate is calculated to Health region with boys having a higher reflect the number of individuals as opposed to hospitalization rate than girls (19.7 per 1,000 the number of hospitalizations (as it is shown in versus 14.3 per 1,000) (Table 13). As was reported Table 12), the hospitalization rate for children for 1-4 year olds in the region, respiratory disease aged 1-4 years was 24.1 per 1,000 population in was the leading cause of hospitalization for both 2006 (males=27.8 per 1,000; females=20.3 per boys and girls. The most frequent reasons for 1,000). Among the children who were being hospitalized for respiratory-related hospitalized in 2006, the average number of conditions were: asthma, tonsils/adenoids, and How healthy are we? / 2007 we? are healthy How hospitalizations was 1.2 for both males and pneumonia; accounting for 62% of the respiratory- females. related admissions to hospital.

22 Table 13: Hospitalizations for males and females Figure 24: Hospitalizations for children 5-9 years old, Capital Health region, 2006 5-9 years old by PHS area, Capital Health region, Leading causes by percent and (rank) 2004-2006 combined Males Females Rate per 1,000 Cause % (rank) % (rank) Capital Health region • 16.7 Respiratory disease 25.1% (1) 27.6% (1) St. Albert • 14.8 Unintentional injury 11.2% (2) 15.0% (2) Castle Downs • 14.3 Digestive disease 9.1% (3) 6.2% (4) Woodcroft • 13.5 Mental disorders 7.6% (4) 1.9% Eastwood • 14.6 Nervous system disease 7.3% (5) 9.5% (3) North Central • 15.6 Genitourinary disease 2.1% 6.0% (5) North East • 16.8 Males Females West Jasper Place • 16.7 Number of hospitalizations 617 420 Twin Brooks • 18.0 Population (2006) 31,273 29,434 Bonnie Doon • 17.4 Hospitalization rate per 1,000 19.7 14.3 Mill Woods • 18.3 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2006). Strathcona County • 14.5 (2) Population data values are for June 30, 2006 and are interpolated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Leduc County • 23.1 Registration File as of March 31, 2006 and 2007. Westview • 17.2

Sturgeon County • 19.3

Fort Saskatchewan • 14.1 When the hospitalization rate is calculated to Sources: (1) Clinical Accountability and Reporting Department, Operational Policy reflect the number of individuals as opposed to and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). the number of hospitalizations (as it is shown in (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Table 13), the hospitalization rate for children 5- Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP 9 years old was 13.3 per 1,000 population in Registration File values and year-over-year population growth values provided by 2006 (males=15.1 per 1,000; females=11.5 per the Health Surveillance Branch of Alberta Health and Wellness. 1,000). Among the children who were hospitalized in 2006, the average number of hospitalizations was 1.3 for males and 1.2 For girls in this age group, mental disorders females. were the leading cause of hospitalization with Hospitalizations by PHS area 41% of these hospitalizations accounted for by There was no significant variation in the behavioural and emotional disorders. hospitalization rate for 5-9 year olds within the When the hospitalization rate is calculated to region. Leduc County had the highest reflect the number of individuals as opposed to hospitalization rate at 23.1 per 1,000 (Figure 24). the number of hospitalizations (as it is shown in Table 14), the hospitalization rate for 10-14 YEAR OLDS children/youth aged 10-14 years was 12.5 per In 2006, there were 15.6 hospitalizations for 1,000 population in 2006 (males=14.1 per 1,000; every 1,000 children aged 10-14 years living in females=10.9 per 1,000). Among the children the Capital Health region with boys having a who were hospitalized in 2006, the average higher hospitalization rate than girls (17.3 per number of hospitalizations was 1.2 for both 1,000 versus 13.9 per 1,000) (Table 14). males and females. Unintentional injury was the leading cause of Hospitalizations by PHS area hospitalization for males in this age group with There was no significant variation in the the top three unintentional injuries being falls hospitalization rate within the region – the rates

How healthy are we? / 2007 we? are healthy How (including sports related falls), being struck by range from 13.2 per 1,000 in Woodcroft public an object/person (including sports), and motor health service area to 21.8 in Fort Saskatchewan vehicle related injury. (Figure 25).

23 Figure 25: Hospitalizations for children Table 14: Hospitalizations for males and females 10-14 years old by PHS area, 10-14 years old, Capital Health region, 2006 Capital Health region, 2004-2006 combined Leading causes by percent and (rank) Rate per 1,000 Males Females Capital Health region • 15.8 Cause % (rank) % (rank) Unintentional injury 20.2% (1) 11.2% (4) St. Albert • 19.3 Mental disorders 14.9% (2) 13.2% (1) Castle Downs • 13.3 Digestive disease 13.7% (3) 11.9% (3) Woodcroft • 13.2 Respiratory disease 7.7% (4) 12.3% (2) Eastwood • 15.4 Nervous system disease 4.7% (5) 8.0% (5) North Central • 13.9 Musculoskeletal/connective North East • 16.1 tissue diseases 4.7% (5) 5.4% West Jasper Place • 13.6 Males Females Twin Brooks • 13.5 Number of hospitalizations* 599 463 Bonnie Doon • 16.8 Population (2006) 34,623 33,260 Mill Woods • 16.1 Hospitalization rate per 1,000* 17.3 13.9 Strathcona County • 15.2 * excludes obstetric/pregnancy-related hospitalizations Leduc County • 18.3 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2006). Westview • 18.4 (2) Population data values are for June 30, 2006 and are interpolated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Sturgeon County • 17.0 Registration File as of March 31, 2006 and 2007.

Fort Saskatchewan • 21.8

Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Table 15: Hospitalizations for males and females Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for 15-19 years old, Capital Health region, 2006 points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over-year population growth values provided by Leading causes by percent and (rank) the Health Surveillance Branch of Alberta Health and Wellness. Males Females Cause % (rank) % (rank) Unintentional injury 23.5% (1) 11.7% (3) 15-19 YEAR OLDS Digestive disease 15.9% (2) 20.8% (1) In 2006, there were 24.4 hospitalizations for Mental disorders 15.7% (3) 14.2% (2) every 1,000 youth aged 15-19 years living in the Capital Health region with males having a Respiratory disease 7.9% (4) 5.2% higher hospitalization rate than females (27.6 Intentional injury 7.5% (5) 3.7% per 1,000 versus 21.0) (Table 15). When the Genitourinary disease 2.5% 7.6% (4) hospitalizations related to pregnancy and Musculoskeletal/connective obstetrics were included, the hospitalization tissue diseases 3.0% 5.3%(5) rate for females doubled to 43.2 per 1,000. Males Females Unintentional injury was the leading cause of hospitalization for males accounting for 23.5% Number of hospitalizations* 1,029 753 of the total hospitalizations with motor vehicle- Population (2006) 37,216 35,779 related injury and falls (including sports related) Hospitalization rate per 1,000* 27.6 21.0 being the two most frequent causes. When hospitalizations due to intentional injury were * excludes obstetric and pregnancy-related hospitalizations Sources: (1) Clinical Accountability and Reporting Department, Operational Policy included this percentage increased from 23.5% and Integration Division, Capital Health (Health Care Utilization Data 2006). (2) Population data values are for June 30, 2006 and are interpolated using actual to 31.0%. population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2006 and 2007.

How healthy are we? / 2007 we? are healthy How For females, the leading cause of hospitalization was diseases of the digestive system – accounting for one fifth of hospitalizations when

24 obstetric/pregnancy related hospitalizations were youth aged 15-19 years and St. Albert had the excluded. Of the digestive disease-related lowest rate at 20.6 per 1,000 (Figure 26). hospitalizations, diseases of the appendix accounted for 29% of hospitalizations and Why do children and youth die? disorders of the gall bladder, biliary tract, and Fortunately, the death rate among young pancreas accounted for another 22%. people in the region is low and, therefore, 10 When the hospitalization rate is calculated to years of data and wider age groups (1-14 years reflect the number of individuals as opposed to and 15-19 years) were used to provide mortality the number of hospitalizations (as it is shown in data for the public health service areas as well Table 15), the hospitalization rate for youth as for the region as a whole. aged 15-19 years was 20.0 per 1,000 population in 2006 (males=22.4 per 1,000; females=17.5 1-14 YEAR OLDS per 1,000). Among the youth who were The mortality rate in the region (1997-2006 hospitalized in 2006, the average number of combined) for children 1-14 years old was 14.3 hospitalizations was 1.2 for both males and deaths per 100,000 population (Figure 27). females. While the mortality rate ranged from a low of Hospitalizations by PHS area 7.3 deaths per 100,000 in Fort Saskatchewan to a high of 20.3 per 100,000 in North East, there The hospitalization rate within the region did were no rates that were significantly higher or not differ significantly among the public health lower than the regional rate. service areas. Fort Saskatchewan had the highest rate at 34.2 hospitalizations per 1,000 Of the 176,826 children aged 1-14 years old living in the Capital Health region, 102 died in

Figure 26: Hospitalizations for children 15-19 years old by PHS area, Figure 27: Mortality rates for children Capital Health region, 2004-2006 combined 1-14 years old by PHS area, Capital Health region, 1997-2006 combined Rate per 1,000 Rate per 100,000 Capital Health region • 24.5 Capital Health region • 14.3 St. Albert • 20.6 St. Albert • 10.5 Castle Downs • 22.00 Castle Downs • 12.7 Woodcroft • 29.0 Woodcroft • 13.1 Eastwood • 29.3 Eastwood • 19.2 North Central • 21.9 North Central • 19.4 North East • 21.6 North East • 20.3 West Jasper Place • 23.7 West Jasper Place • 12.1 Twin Brooks • 22.2 Twin Brooks • 10.7 Bonnie Doon • 24.4 Bonnie Doon • 13.1 Mill Woods • 21.1 Mill Woods • 17.9 Strathcona County • 22.7 Strathcona County • 10.0 Leduc County • 26.3 Leduc County • 12.5 Westview • 27.6 Westview • 13.6 Sturgeon County • 29.1 Sturgeon County • 13.8 Fort Saskatchewan • 34.2 Fort Saskatchewan • 7.3 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). Sources: (1) Vital Statistics (Death Data), 1997-2006. (2) Population data values are (2) Population data values are for June 30. Values up to March 31, 2007 are for June 30. Values up to March 31, 2007 are interpolations of actual population

How healthy are we? / 2007 we? are healthy How interpolations of actual population values from the Alberta Health Care Insurance values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for March 31 for each year. Forecast values for points in time after March 31, 2007 are points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP estimated using the March 31, 2007 AHCIP Registration File values and year-over- Registration File values and year-over-year population growth values provided by year population growth values provided by the Health Surveillance Branch of the Health Surveillance Branch of Alberta Health and Wellness. Alberta Health and Wellness.

25 Figure 28: Leading causes of death for Figure 29: Mortality rates for children 1-14 year olds, Capital Health region, 2006 15-19 years old by PHS area, I Male deaths = 66 I Female deaths = 36 Capital Health region, 1997-2006 combined By percent Rate per 100,000 Perinatal conditions 33.3 Capital Health region • 46.5 44.4 St. Albert • 19.7 Congenital anomalies 19.7 25.0 Castle Downs • 30.5

Cancer 15.2 Woodcroft • 77.5 13.9 Eastwood • 42.8

Other causes 31.9 North Central • 60.6 16.7 North East • 45.9 Source: Vital Statistics (Death Data), 2006. West Jasper Place • 31.9

Twin Brooks • 26.9 2006. The leading cause of death (Figure 28) Bonnie Doon • 41.4 for both males and females was conditions originating in the perinatal period – accounting Mill Woods • 38.7 for 33.3% of the deaths in males and 44.4% of Strathcona County • 37.6 the deaths in females. Males in this age group Leduc County • 70.8 had a higher death rate than females – 73 per 100,000 compared to 42 per 100,000. Westview • 68.2 Sturgeon County • 61.9 15-19 YEAR OLDS Fort Saskatchewan • 59.6 The regional mortality rate using 10 years of Sources: (1) Vital Statistics (Death Data), 1997-2006. (2) Population data values are data (1997-2006) is 46.5 per 100,000 15-19 year for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of olds living in the region (Figure 29). Although March 31 for each year. Forecast values for points in time after March 31, 2007 are there is variation in the mortality rate for this estimated using the March 31, 2007 AHCIP Registration File values and year-over- year population growth values provided by the Health Surveillance Branch of age group among the public health service Alberta Health and Wellness. areas, only two public health service areas had significantly lower mortality rates than the region, St. Albert and Twin Brooks. school districts in St. Albert and the Evergreen There were 72,995 youth aged 15-19 years old Catholic Schools in had higher living in the Capital Health region in 2006 and high school completion rates than school 35 died in this year. Due to the small number of districts in Edmonton, , and Alberta. deaths, a detailed breakdown by cause and sex is not shown. Teen birth rate Injury, including unintentional and intentional, Over the last 10 years, there has been a was the cause of 67% of the female deaths and decrease in the teen birth rate in the Capital 70% of the male deaths. Health region (Figure 30). Since 2002, it has hovered around 16 births per 1,000 young Education women aged 15-19 years. While the downward Education is fundamental to people’s ability to trend is encouraging, there is concern about the lead healthy lives. High school completion is high teen birth rates in parts of the Capital one indicator that can be used to assess not Health region. Four areas – North East, North only school success but also the health of a Central, Eastwood, and Woodcroft - had community. Table 16 highlights the percentage significantly higher teen birth rates than the of the region’s population that completed high regional rate for 2004-2006 (Figure 31). school within three years of starting grade 10.

How healthy are we? / 2007 we? are healthy How There are 12 school districts in the Capital Health region 11 of which have high school completion data. For the 2005-06 school year,

26 Table 16: Percentage completing high school within three years of starting grade 10, Capital Health region, 2000-2001 to 2005-2006 School District 2001-02 2002-03 2003-04 2004-05 2005-06 Edmonton Public Schools 57.3% 57.6% 60.5% 63.6% 63.5% Edmonton Catholic Schools 61.7% 64.1% 69.3% 68.5% 70.5% St. Albert Protestant Separate Schools 72.5% 72.4% 76.6% 80.2% 80.2% Greater St. Albert Catholic Schools 72.5% 74.4% 76.6% 78.9% 79.8% Sturgeon (Sturgeon County) 62.4% 70.1% 72.7% 75.6% 70.8% Black Gold Regional Schools (Leduc County) 72.8% 76.7% 74.5% 78.6% 75.5% St. Thomas Aquinas Regional Catholic Schools (Leduc County) 62.1% 67.1% 72.9% 66.2% 56.2% Parkland School Division (Parkland County) 65.1% 69.5% 64.0% 70.1% 68.8% Evergreen Catholic Schools (Parkland County) 73.3% 74.5% 72.9% 71.6% 82.0% Elk Island Public Schools (Strathcona County) 77.0% 78.1% 78.6% 78.1% 76.9% Elk Island Catholic Schools (Strathcona County) 77.1% 82.2% 81.2% 76.6% 77.5% Calgary Board of Education #19 65.2% 66.5% 68.6% 70.3% 69.5% Calgary Roman Catholic Separate School District 69.7% 73.0% 75.0% 76.9% 74.6% Alberta 65.6% 67.8% 69.3% 70.4% 70.4%

Source: Alberta Education. Alberta High School Completion Rates, June 2007. www.education.gov.ab.ca

Figure 30: Teen birth rate, Capital Health region, Figure 31: Teen birth rate by PHS area, 1995-1997 to 2004-2006 Capital Health region, 2004-2006 combined Number of births per 1,000 females 15-19 years of age Number of births per 1,000 females 15-19 years of age 1995-1997 24.5 Capital Health region • 16.1

1996-1998 22.9 St. Albert • 4.9

1997-1999 22.1 Castle Downs • 17.9

1998-2000 21.3 Woodcroft • 33.0

1999-2001 19.3 Eastwood • 39.3

2000-2002 17.6 North Central • 21.9

2001-2003 16.8 North East • 26.1

2002-2004 16.1 West Jasper Place • 16.6

2003-2005 16.0 Twin Brooks • 6.9

2004-2006 16.1 Bonnie Doon • 12.8

Sources: (1) Vital Statistics (Birth Data) 2004-2006. (2) Population data values are Mill Woods • 13.8 for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of Strathcona County• 4.9 March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over- Leduc County • 10.3 year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness. Westview • 16.2

Sturgeon County • 15.9

Fort Saskatchewan • 14.6

Source: (1) Vital Statistics (Birth Data) 2004-2006. (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population

How healthy are we? / 2007 we? are healthy How values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over- year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness.

27 Health through the ages: Adults

All of the public health service areas had a Why do adults go to the emergency similar percentage of adults aged 20-64 years department (ED)? (Figure 32). North Central had the lowest percentage of 20-64 year olds at 58.6% and 20-44 YEARS OLD Eastwood had the highest percentage at 69.0%. The emergency department visit rate for males In terms of numbers, Mill Woods, West Jasper and females in this age group was very similar Place and Twin Brooks had the highest number with males having a rate of 393.2 per 1,000 of adults aged 20-64 years (Figure 33). and females having a rate of 395.4 per 1,000

Figure 32: Percentage population by age group, Capital Health region, 2007 I 0-19 years I 20-64 years I 65+ years St. Albert 27.0 62.9 10.1

Castle Downs 28.4 63.0 8.5

Woodcroft 18.0 67.4 14.6

Eastwood 19.1 69.0 11.8

North Central 26.7 58.6 14.8

North East 27.4 63.4 9.3

West Jasper Place 25.0 62.7 12.3

Twin Brooks 25.0 62.8 12.2

Bonnie Doon 18.0 65.8 16.2

Mill Woods 28.6 64.5 6.9

Strathcona County 27.6 63.3 9.1

Leduc County 27.7 62.2 10.1

Westview 28.6 61.4 10.0

Sturgeon County 31.5 60.1 8.3

Fort Saskatchewan 27.1 62.7 10.3

Source: Population data values are for June 30 and are estimated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2007 and forecast percent population growth from June 2006 and June 2007 from the Health Surveillance Branch of Alberta Health and Wellness. How healthy are we? / 2007 we? are healthy How

28 Figure 33: Number of adults 20-64 years old, Capital Health region, 2007 I 20-44 years I 45-64 years St. Albert 19,033 17,205

Castle Downs 19,077 12,077

Woodcroft 33,615 21,099

Eastwood 26,291 16,833

North Central 24,901 17,015

North East 30,202 19,576

West Jasper Place 39,707 28,406

Twin Brooks 38,613 26,466

Bonnie Doon 35,575 22,191

Mill Woods 43,225 27,075

Strathcona County 28,312 24,832

Leduc County 15,402 11,790

Westview 25,757 20,987

Sturgeon County 10,749 8,512

Fort Saskatchewan 5,528 4,194

0 10,000 20,000 30,000 40,000 50,000 60,000 70,000

Source: Population data values are for June 30 and are estimated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2007 and forecast percent population growth from June 2006 and June 2007 from the Health Surveillance Branch of Alberta Health and Wellness.

(Table 17). Unintentional injury was the leading Table 17: Emergency department visits cause of emergency department visits for both for males and females 20-44 years old, men and women aged 20-44 years in 2006. Of Capital Health region, 2006 these unintentional injury-related ED visits, Leading causes by percent and (rank) about one third were due to falls (including Males Females sports) or being struck by an object or person Cause % (rank) % (rank) (including sports). Another 12% of these visits Unintentional injury 32.7% (1) 16.9% (1) were classified under ‘cut/pierce’. Digestive disease 6.4% (2) 7.4% (3) When the emergency department visit rate is Respiratory disease 6.2% (3) 7.2% (4) calculated to reflect the number of individuals as opposed to the number of visits (as it is Musculoskeletal/connective shown in Table 17), the ED visit rate for adults tissue diseases 5.7% (4) 4.7% 20-44 years old was 220.4 per 1,000 Mental disorders 5.3% (5) 4.2% population in 2006 (males=224.3 per 1,000; Pregnancy/childbirth - 8.8% (2) females=216.7 per 1,000). Among the adults Genitourinary disease 2.5% 6.7% (5) who went to the emergency department in 2006, the average number of visits was 1.7 for Males Females males and 1.8 for females. Number of ED visits 75,086 75,554 Emergency department (ED) visits by PHS area Population (2006) 190,970 193,622 The overall emergency department visit rate ED visit rate per 1,000 393.2 395.4 varied within the region with the rural areas Sources: (1) Clinical Accountability and Reporting Department, Operational Policy (excluding Strathcona County) as well as and Integration Division, Capital Health (Health Care Utilization Data 2006). (2) Population data values are for June 30, 2006 and are interpolated using actual Eastwood and North East having significantly population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2006 and 2007. How healthy are we? / 2007 we? are healthy How higher ED visit rates than the region (Figure 34). Strathcona County had the lowest rate at 195.0 per 1,000 population.

29 Figure 34: Emergency department visits for Table 18: Emergency department visits adults 20-44 years old by PHS area, for males and females 45-64 years old, Capital Health region, 2004-2006 combined Capital Health region, 2006 Rate per 1,000 Leading causes by percent and (rank) Capital Health region • 389.2 Males Females Cause % (rank) % (rank) St. Albert • 368.7 Unintentional injury 21.7% (1) 17.9% (1) Castle Downs • 346.8 Mental disorders 7.4% (2) 3.7% Woodcroft • 359.4 Digestive disease 7.1% (3) 8.0% (2) Eastwood • 545.0 Musculoskeletal/connective North Central • 407.2 tissue diseases 6.8% (4) 6.9% (4) North East • 469.3 Circulatory disease 6.1% (5) 4.4% West Jasper Place • 327.9 Respiratory disease 6.0% 7.1% (3) Twin Brooks • 227.6 Nervous system disease 4.6% 6.3% (5) Bonnie Doon • 282.7 Males Females Mill Woods • 322.9 Number of ED visits 43,634 39,551 Strathcona County• 195.0 Population (2006) 133,649 133,207 Leduc County • 620.5 ED visit rate per 1,000 326.5 296.9

Westview • 628.5 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2006). Sturgeon County • 544.0 (2) Population data values are for June 30, 2006 and are interpolated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Fort Saskatchewan • 735.3 Registration File as of March 31, 2006 and 2007.

Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Table 19: Hospitalizations for males and females Registration File values and year-over-year population growth values provided by 20-44 years old, Capital Health region, 2006 the Health Surveillance Branch of Alberta Health and Wellness. Leading causes by percent and (rank) Males Females Cause % (rank) % (rank) 45-64 YEARS OLD Mental disorders 18.2% (1) 15.4% (2) In this age group, females had a lower ED visit Unintentional injury 17.6% (2) 5.9% (4) rate (296.9 per 1,000) than males (326.5) (Table 18). As was observed in the 20-44 year Digestive disease 15.7% (3) 17.7% (1) age group, unintentional injury was the leading Musculoskeletal/connective cause of visits to the emergency department tissue diseases 6.5% (4) 4.4% for both males and females. Falls (including Intentional injury 6.3% (5) 1.3% sports) accounted for 30% of the unintentional Genitourinary disease 2.3% 15.1% (3) injury-related ED visits. Overexertion/strenuous movement accounted for another 10% of these Benign, in situ, and visits. uncertain tumours 0.8% 5.3% (5) When the emergency department visit rate is Males Females calculated to reflect the number of individuals Number of hospitalizations* 6,297 6,813 as opposed to the number of visits (as it is Population (2006) 190,970 193,622 shown in Table 18), the ED visit rate for adults 45-64 years old was 174.1 per 1,000 population Hospitalization rate per 1,000* 33.0 35.2 in 2006 (males=178.9 per 1,000; females=169.2 * excludes obstetric/pregnancy-related hospitalizations per 1,000). Among the adults who went to the Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2006). How healthy are we? / 2007 we? are healthy How emergency department in 2006, the average (2) Population data values are for June 30, 2006 and are interpolated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) number of visits was 1.8 for both males and Registration File as of March 31, 2006 and 2007. females.

30 Emergency department (ED) visits by PHS area personality disorders, and delusional disorders Fort Saskatchewan had an ED visit rate of 737.9 accounted for 35% of hospitalizations; mental per 1,000 – more than twice the regional rate of disorders due to psychoactive substance use 319.0 per 1,000 people aged 45-64 years old accounted for 26% and mood disorders (Figure 35). The other public health service areas accounted for 21%. that had a significantly higher ED visit rate than For females, aged 20-44 years, digestive the regional rate include: Eastwood, North disease was the leading cause of hospitalization. Central, North East, as well as the more rural Over half (66%) of the digestive disease-related areas of the region – Leduc County, Westview, hospitalizations were for diseases of the and Sturgeon County. appendix (17%), non-infective enteritis and colitis (11%), and disorders of the gallbladder, biliary Why do adults go to the hospital? tract, and pancreas (38%).

20-44 YEARS OLD When the hospitalization rate is calculated to reflect the number of individuals as opposed to The hospitalization rates for males and females the number of hospitalizations (as it is shown in were very similar at 35.2 per 1,000 for females and Table 19), the hospitalization rate for adults aged 33.0 per 1,000 for males (Table 19). When 20-44 years was 26.9 per 1,000 population in obstetric / pregnancy-related hospitalizations are 2006 (males=25.9 per 1,000; females=27.9 per included, the rate for females was 109.9 per 1,000. 1,000). Among the adults who were hospitalized The leading cause of hospitalization for males in 2006, the average number of hospitalizations 20-44 years old was mental disorders and of was 1.3 for both males and females. these hospitalizations, schizophrenia, schizotypal

Figure 35: Emergency department visits for Figure 36: Hospitalizations for adults adults 45-64 years old by PHS area, 20-44 years old by PHS area, Capital Health region, 2004-2006 combined Capital Health region, 2004-2006 combined Rate per 1,000 Rate per 1,000 Capital Health region • 319.0 Capital Health region • 34.1

St. Albert • 272.9 St. Albert • 30.4

Castle Downs • 271.5 Castle Downs • 31.9

Woodcroft • 301.6 Woodcroft • 36.2

Eastwood • 490.1 Eastwood • 54.3

North Central • 332.9 North Central • 33.1

North East • 399.8 North East • 35.2

West Jasper Place • 254.3 West Jasper Place • 32.4

Twin Brooks • 177.1 Twin Brooks • 24.9

Bonnie Doon • 233.7 Bonnie Doon • 29.9

Mill Woods • 268.7 Mill Woods • 28.4

Strathcona County• 177.8 Strathcona County • 27.4

Leduc County • 458.6 Leduc County • 35.0

Westview • 479.9 Westview • 34.7

Sturgeon County • 515.7 Sturgeon County • 41.3

Fort Saskatchewan • 737.9 Fort Saskatchewan • 47.0

Sources: (1) Clinical Accountability and Reporting Department, Operational Policy Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). (2) Population data values are for June 30. Values up to March 31, 2007 are (2) Population data values are for June 30. Values up to March 31, 2007 are

How healthy are we? / 2007 we? are healthy How interpolations of actual population values from the Alberta Health Care Insurance interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over-year population growth values provided by Registration File values and year-over-year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness. the Health Surveillance Branch of Alberta Health and Wellness.

31 Hospitalizations by PHS area Table 20), the hospitalization rate for adults Twin Brooks had the lowest hospitalization rate aged 45-64 years was 51.6 per 1,000 population in the region for this age group at 24.9 per in 2006 (males=52.0 per 1,000; females=51.2 1,000 whereas Eastwood has the highest rate at per 1,000). Among the adults who were 54.3 per 1,000 (Figure 36). The other public hospitalized in 2006, the average number of health service areas with significantly higher hospitalizations was 1.3 for both males and hospitalization rates than the region were females. Sturgeon County and Fort Saskatchewan. Hospitalizations by PHS area At 101.8 hospitalizations per 1,000 population, 45-64 YEARS OLD Eastwood had the highest hospitalization rate Digestive disease remained the leading cause within the region for adults aged 45-64 years of hospitalization for females, followed by (Figure 37). There are several public health cancer, while it was circulatory disease that service areas with rates that were significantly became the leading cause of hospitalization for lower than the regional rate including St. Albert, males (15.9%) albeit it was closely followed by Castle Downs, West Jasper Place, Twin Brooks, digestive disease (15.3%) (Table 20). Mill Woods, and Strathcona County. Within the digestive disease-related hospitalizations for female, the leading causes What do adults die from? were disorders of the gallbladder, biliary tract, Cancer was the leading cause of death for and pancreas (32%), hernia (9%) and diseases females in the 20-44 year age group as well as of the appendix (9%). In men, over half of the the 45-64 year age group in 2006 (Figure 38 hospitalizations for circulatory disease were due to ischemic heart disease (57%). When the hospitalization rate is calculated to Figure 37: Hospitalizations for adults reflect the number of individuals as opposed to 45-64 years old by PHS area, the number of hospitalizations (as it is shown in Capital Health region, 2004-2006 combined Rate per 1,000 Capital Health region • 67.3

St. Albert • 56.2 Table 20: Hospitalizations for males and females 45-64 years old, Capital Health region, 2006 Castle Downs • 60.7 Leading causes by percent and (rank) Woodcroft • 76.4 Males Females Eastwood • 101.8 Cause % (rank) % (rank) Circulatory disease 15.9% (1) 7.1% North Central • 66.6 Digestive disease 15.3% (2) 13.9% (1) North East • 71.4 Cancer 10.2% (3) 11.7% (2) West Jasper Place • 60.0 Musculoskeletal/connective Twin Brooks • 54.1 tissue diseases 9.8% (4) 10.5% (4) Bonnie Doon • 64.9

Unintentional injury 7.4% (5) 6.0% Mill Woods • 58.6

Genitourinary disease 3.4% 11.3% (3) Strathcona County • 59.4

Mental disorders 6.8% 8.0% (5) Leduc County • 73.1

Males Females Westview • 68.5

Number of hospitalizations* 9,165 8,605 Sturgeon County • 83.2

Population (2006) 133,649 133,207 Fort Saskatchewan • 79.1

Hospitalization rate per 1,000* 68.6 64.6 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). * excludes obstetric and pregnancy-related hospitalizations (2) Population data values are for June 30. Values up to March 31, 2007 are

How healthy are we? / 2007 we? are healthy How Sources: (1) Clinical Accountability and Reporting Department, Operational Policy interpolations of actual population values from the Alberta Health Care Insurance and Integration Division, Capital Health (Health Care Utilization Data 2006). Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for (2) Population data values are for June 30, 2006 and are interpolated using actual points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File values and year-over-year population growth values provided by Registration File as of March 31, 2006 and 2007. the Health Surveillance Branch of Alberta Health and Wellness.

32 Figure 38: Leading causes of death for and 39). However, when unintentional, 20-44 year olds, Capital Health region, 2006 intentional, and injury with undetermined intent I Male deaths = 253 I Female deaths = 129 were grouped together, then injury became the By percent leading cause of death for females aged 20-44 Intentional injury 26.1 years accounting for 35% of the deaths. 14.7 For males aged 20-44 years, intentional injury Unintentional injury 17.4 accounted for approximately one quarter of the 10.9 deaths in 2006. Of these deaths, 70% were due Circulatory disease 15.0 to suicide. When unintentional injury and injury 4.7 with undetermined intent were added, this Injury, undetermined 14.6 percentage increased to 58% of deaths. For the intent 9.3 older males, between 45 and 64 years of age, Cancer 7.9 circulatory disease (including heart disease and 27.1 stroke) and cancer contributed to just over 60% of deaths. Nervous system 4.3 disease 2.3 Deaths by PHS area Infectous/parasitic 3.6 diseases 4.7 20-24 YEAR OLDS Respiratory disease 2.4 Over a 10 year period, 1997 to 2006, 442 young 8.5 adults in this age group died. The 10 year Digestive disease 2.4 combined mortality rate for the region was 63.0 7.8 per 100,000 20-24 year olds (Figure 40). Mental disorders 2.0 5.4 Figure 40: Mortality rate for adults 20-24 years All other causes 4.3 4.7 old by PHS area, Capital Health region, 1997-2006 combined Source: Vital Statistics (Death Data), 2006. Rate per 100,000 Capital Health region • 63.0

St. Albert • 42.8 Figure 39: Leading causes of death for 45-64 year olds, Capital Health region, 2006 Castle Downs • 56.4 I Male deaths = 751 I Female deaths = 441 Woodcroft • 80.5 By percent Eastwood • 63.1 Cancer 34.1 54.6 North Central • 81.1 Circulatory disease 28.0 North East • 64.4 13.4 West Jasper Place • 51.7 Respiratory disease 7.5 Twin Brooks • 49.7 4.8 Bonnie Doon • 54.0 Intentional injury 6.1 2.5 Mill Woods • 55.4

Unintentional injury 4.8 Strathcona County • 43.3 1.8 Leduc County • 45.9 Injury, undetermined 4.3 intent 3.6 Westview • 83.5 Digestive disease 3.9 Sturgeon County • 90.7 5.4 Fort Saskatchewan • 60.0 Nervous system 2.9 Source: (1) Vital Statistics (Death Data) 1997-2006. (2) Population data values are disease 3.6 for June 30. Values up to March 31, 2007 are interpolations of actual population

How healthy are we? / 2007 we? are healthy How values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of All other causes 8.5 March 31 for each year. Forecast values for points in time after March 31, 2007 are 10.2 estimated using the March 31, 2007 AHCIP Registration File values and year-over- year population growth values provided by the Health Surveillance Branch of Source: Vital Statistics (Death Data), 2006. Alberta Health and Wellness.

33 Although there was variation in the death rate 35-44 YEAR OLDS for these young adults within the region, with a Over a 10 year period, 1997 to 2006, 2,187 high of 90.7 per 100,000 in Sturgeon County adults between 35 and 44 years old died. The and a low of 43.3 per 100,000 and 42.8 per 10 year combined mortality rate (1997-2006) 100,000 in Strathcona County and St. Albert for the region was 135.2 per 100,000 35-44 year respectively, the differences among public olds (Figure 42). The mortality rate among the health service areas were not significant and no public health service areas varied from a low of one public health service area had a mortality 68.0 per 100,000 in St. Albert to a rate that was rate that was statistically higher or lower than over four times as high in Eastwood (294.4 per the region. 100,000).

25-34 YEAR OLDS Woodcroft and Eastwood public health service areas had significantly higher mortality rates than Over a 10 year period, 1997 to 2006, 1,079 the region while St. Albert, Castle Downs, Twin adults in this age group died. The 1997-2006 Brooks, Mill Woods, and the counties of mortality rate for the region was 76.7 per Strathcona, Leduc and Sturgeon had significantly 100,000 25-34 year olds (Figure 41). The lower rates than the region. mortality rate among the public health service areas varied from a low of 50 per 100,000 in 45-54 YEAR OLDS Twin Brooks and Bonnie Doon public health service areas to over two and a half times that Over a 10 year period, 1997 to 2006, just over in Eastwood (138.7per 100,000). 4,000 adults died (n=4,060). The 10 year combined mortality rate (1997-2006) for the

Figure 41: Mortality rate for adults 25-34 years Figure 42: Mortality rate for adults 35-44 years old by PHS area, Capital Health region, old by PHS area, Capital Health region, 1997-2006 combined 1997-2006 combined Rate per 100,000 Rate per 100,000 Capital Health region • 76.7 Capital Health region • 135.2

St. Albert • 65.9 St. Albert • 68.0

Castle Downs • 76.0 Castle Downs • 105.2

Woodcroft • 87.2 Woodcroft • 181.4

Eastwood • 138.7 Eastwood • 294.4

North Central • 72.7 North Central • 137.8

North East • 68.0 North East • 145.0

West Jasper Place • 79.2 West Jasper Place • 128.2

Twin Brooks • 50.0 Twin Brooks • 82.6

Bonnie Doon • 50.1 Bonnie Doon • 132.0

Mill Woods • 59.2 Mill Woods • 110.8

Strathcona County • 66.0 Strathcona County • 91.2

Leduc County • 56.9 Leduc County • 98.0

Westview • 86.8 Westview • 124.2

Sturgeon County • 70.5 Sturgeon County • 93.6

Fort Saskatchewan • 77.0 Fort Saskatchewan • 118.2

Source: (1) Vital Statistics (Death Data) 1997-2006. (2) Population data values are Source: (1) Vital Statistics (Death Data) 1997-2006. (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population for June 30. Values up to March 31, 2007 are interpolations of actual population

How healthy are we? / 2007 we? are healthy How values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over- estimated using the March 31, 2007 AHCIP Registration File values and year-over- year population growth values provided by the Health Surveillance Branch of year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness. Alberta Health and Wellness.

34 Figure 43: Mortality rate for adults 45-54 years Figure 44: Mortality rate for adults 55-64 years old by PHS area, Capital Health region, old by PHS area, Capital Health region, 1997-2006 combined 1997-2006 combined Rate per 100,000 Rate per 100,000 Capital Health region • 292.6 Capital Health region • 712.2 St. Albert • 207.4 St. Albert • 539.4

Castle Downs • 237.9 Castle Downs • 598.0

Woodcroft • 402.6 Woodcroft • 928.9

Eastwood • 605.1 Eastwood • 1,231.9

North Central • 315.9 North Central • 764.6

North East • 312.1 North East • 803.3

West Jasper Place • 260.2 West Jasper Place • 646.5

Twin Brooks • 198.3 Twin Brooks • 510.2

Bonnie Doon • 328.7 Bonnie Doon • 724.2

Mill Woods • 222.8 Mill Woods • 587.2

Strathcona County • 199.6 Strathcona County • 511.0

Leduc County • 230.6 Leduc County • 660.5

Westview • 271.2 Westview • 701.2

Sturgeon County • 283.5 Sturgeon County • 761.5

Fort Saskatchewan • 268.1 Fort Saskatchewan • 693.6

Source: (1) Vital Statistics (Death Data) 1997-2006. (2) Population data values are Source: (1) Vital Statistics (Death Data) 1997-2006. (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over- estimated using the March 31, 2007 AHCIP Registration File values and year-over- year population growth values provided by the Health Surveillance Branch of year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness. Alberta Health and Wellness.

region was 292.6 per 100,000 45-54 year olds (Figure 43). Public health service areas with significantly higher mortality rates than the regional rate included Woodcroft and Eastwood. Significantly lower rates were experienced by St. Albert, Castle Downs, Twin Brooks, Mill Woods, Strathcona County, and Leduc County.

55-64 YEAR OLDS Over a 10 year period, 1997 to 2006, 6,062 adults died. The 10 year combined mortality rate (1997- 2006) for the region was 712.2 per 100,000 55-64 year olds (Figure 44). The public health service areas with significantly higher mortality rates than the regional rate include: Woodcroft, Eastwood and North East. Significantly lower rates were experienced by St. Albert, Castle Downs, Twin Brooks, Mill Woods, and Strathcona County. How healthy are we? / 2007 we? are healthy How

35 Health through the ages: Seniors

In the Capital Health region, seniors aged 65 years In terms of numbers, the three public health and older made up 11.2% of the population in service areas that had the highest number of 2007. Among public health service areas, Bonnie seniors in 2007 were Bonnie Doon (14,185), West Doon, North Central and Woodcroft had the Jasper Place (13,351), and Twin Brooks (12,641) highest percentage of seniors. Millwoods had the (Table 21, Figures 45-48). lowest percentage of seniors (Table 21).

Table 21: Number (percentage) seniors in selected age groups by PHS area, Capital Health region, 2007 PHS Area 65+years 75+ years 85+ years 65-74 years 75-84 years St. Albert 5,845 (10.1) 2,466 (4.3) 619 (1.1) 3,379 (5.9) 1,847 (3.2) Castle Downs 4,225 (8.5) 1,670 (3.4) 329 (0.7) 2,555 (5.2) 1,340 (2.7) Woodcroft 11,868 (14.6) 6,556 (8.1) 1,979 (2.4) 5,312 (6.5) 4,577 (5.6) Eastwood 7,397 (11.8) 3,875 (6.2) 1,210 (1.9) 3,522 (5.6) 2,665 (4.3) North Central 10,560 (14.8 ) 4,923 (6.9) 1,219 (1.7) 5,638 (7.9) 3,704 (5.2) North East 7,272 (9.3) 2,849 (3.6) 565 (0.7) 4,423 (5.6) 2,284 (2.9) West Jasper Place 13,351 (12.3) 6,594 (6.1) 1,698 (1.6) 6,757 (6.2) 4,896 (4.5) Twin Brooks 12,641 (12.2) 5,804 (5.6) 1,490 (1.4) 6,837 (6.6) 4,314 (4.2) Bonnie Doon 14,185 (16.2) 8,044 (9.2) 2,299 (2.6) 6,141 (7.0) 5,745 (6.5) Mill Woods 7,504 (6.9) 3,096 (2.8) 723 (0.7) 4,407 (4.0) 2,373 (2.2) Strathcona County 7,644 (9.1) 2,823 (3.4) 702 (0.8) 4,821 (5.7) 2,121 (2.5) Leduc County 4,416 (10.1) 1,950 (4.5) 498 (1.1) 2,466 (5.6) 1,453 (3.3) Westview 7,599 (10.0) 2,930 (3.9) 711 (0.9) 4,669 (6.1) 2,219 (2.9) Sturgeon County 2,672 (8.3) 1,058 (3.3) 235 (0.7) 1,614 (5.0) 823 (2.6) Fort Saskatchewan 1,592 (10.3) 727 (4.7) 234 (1.5) 865 (5.6) 494 (3.2) Capital Health region 118,770 (11.2) 55,365 (5.2) 14,511 (1.4) 63,405 (6.0) 40,855 (3.9)

Source: Population data values are for June 30 and are estimated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2007 and forecast percent population growth from June 2006 and June 2007 from the Health Surveillance Branch of Alberta Health and Wellness. How healthy are we? / 2007 we? are healthy How

36 Figure 45: Number of seniors by age group and PHS area, Capital Health region, 2007 I 65-74 years I 75-84 years I 85+ years St. Albert Castle Downs Woodcroft Eastwood North Central North East West Jasper Place Twin Brooks Bonnie Doon Mill Woods Strathcona County Leduc County Westview Sturgeon County Fort Saskatchewan

0 5,000 10,000 15,000

Source: Population data values are for June 30 and are estimated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2007 and forecast percent population growth from June 2006 and June 2007 from the Health Surveillance Branch of Alberta Health and Wellness.

Figure 46: Number of seniors aged 65-74 years, Figure 47: Number of seniors aged 75-84 years, Capital Health region, 2007 Capital Health region, 2007

St. Albert 3,379 St. Albert 1,847

Castle Downs 2,555 Castle Downs 1,340

Woodcroft 5,312 Woodcroft 4,577

Eastwood 3,522 Eastwood 2,665

North Central 5,638 North Central 3,704

North East 4,423 North East 2,284

West Jasper Place 6,757 West Jasper Place 4,896

Twin Brooks 6,837 Twin Brooks 4,314

Bonnie Doon 6,141 Bonnie Doon 5,745

Mill Woods 4,407 Mill Woods 2,373

Strathcona County 4,821 Strathcona County 2,121

Leduc County 2,466 Leduc County 1,453

Westview 4,669 Westview 2,219

Sturgeon County 1,614 Sturgeon County 823

Fort Saskatchewan 865 Fort Saskatchewan 494

Source: Population data values are for June 30 and are estimated using actual Source: Population data values are for June 30 and are estimated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) population values from the Alberta Health Care Insurance Plan (AHCIP)

How healthy are we? / 2007 we? are healthy How Registration File as of March 31, 2007 and forecast percent population growth Registration File as of March 31, 2007 and forecast percent population growth from June 2006 and June 2007 from the Health Surveillance Branch of Alberta from June 2006 and June 2007 from the Health Surveillance Branch of Alberta Health and Wellness. Health and Wellness.

37 Figure 48: Number of seniors aged 85+ years, Table 22: Emergency department (ED) visits for Capital Health region, 2007 males and females 65-74 years old, Capital Health region, 2006 St. Albert 619 Leading causes by percent and (rank) Castle Downs 329 Males Females Woodcroft 1,979 Cause % (rank) % (rank)

Eastwood 1,210 Unintentional injury 12.4% (1) 14.1% (1)

North Central 1,219 Circulatory disease 11.3% (2) 9.0% (2)

North East 565 Respiratory disease 9.5% (3) 8.8% (3+)

West Jasper Place 1,698 Digestive disease 8.2% (4) 8.8% (3+)

Twin Brooks 1,490 Musculoskeletal/connective tissue diseases 5.3% (5) 6.9% (4) Bonnie Doon 2,299 Males Females Mill Woods 723 Number of ED visits 13,118 12,582 Strathcona County 702 Population (2006) 29,561 32,174 Leduc County 498 ED visit rate per 1,000 443.8 391.1 Westview 711 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy Sturgeon County 235 and Integration Division, Capital Health (Health Care Utilization Data 2006). (2) Population data values are for June 30, 2006 and are interpolated using actual Fort Saskatchewan 234 population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2006 and 2007. Source: Population data values are for June 30 and are estimated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2007 and forecast percent population growth from June 2006 and June 2007 from the Health Surveillance Branch of Alberta Figure 49: Emergency department visits for Health and Wellness. seniors 65-74 years old by PHS area, Capital Health region, 2004-2006 combined Rate per 1,000 Why do seniors go to the emergency Capital Health region • 433.8 department (ED)? St. Albert • 434.2 65-74 YEAR OLDS Castle Downs • 365.4 In the 65-74 year age group, the ED visit rate Woodcroft • 405.7 for males was higher than females in 2006 Eastwood • 550.9 (Table 22). However, the most common reason North Central • 460.4 for going to the emergency department was the same for both males and females – North East • 570.4 unintentional injury. Falls contributed to 50% West Jasper Place • 373.8 of the unintentional injury-related visits. Twin Brooks • 279.5 When the emergency department visit rate is Bonnie Doon • 334.6 calculated to reflect the number of individuals as opposed to the number of visits (as it is Mill Woods • 358.1 shown in Table 22), the ED visit rate for seniors Strathcona County• 290.3 65-74 years old was 222.9 per 1,000 Leduc County • 634.1 population in 2006 (males=231.1 per 1,000; females=215.3 per 1,000). Among the seniors Westview • 618.6 who went to the emergency department in Sturgeon County • 687.5 2006, the average number of visits was 1.9 for Fort Saskatchewan • 953.7 males and 1.8 for females. Source: (1) Clinical Accountability and Reporting Department, Operational Policy Emergency department (ED) visits by PHS area and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). (2) Population data values are for June 30. Values up to March 31, 2007 are

How healthy are we? / 2007 we? are healthy How The rural areas of the region experienced higher interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for ED visit rates than in other public health service points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over-year population growth values provided by areas (Figure 49). As mentioned earlier in the the Health Surveillance Branch of Alberta Health and Wellness.

38 report, the higher ED visit rates consistently Emergency Department (ED) visits by PHS area observed in these areas, across all age groups Significantly higher rates than the regional rate may be due to the limited after-hours access to of 693.4 per 1,000 were found in: Leduc health services other than at the emergency County, Westview, Sturgeon County, Fort department. Eastwood, North Central, and North Saskatchewan, St. Albert, Eastwood, North East also had significantly higher rates than the Central, and North East (Figure 50). The regional rate of 433.8 per 1,000. lowest rate was in Twin Brooks at 507.3 per 1,000. 75+ YEAR OLDS Unintentional injury was the leading cause of Why do seniors go to the hospital? emergency department visits for females aged 75 years and older with falls accounting for one third 65-74 YEAR OLDS of the injury-related ED visits (Table 23). For men, There were over 9,000 hospitalizations in 2006 circulatory disease was the number one reason for for seniors between 65 and 74 years of age going to the emergency department with with males having a higher hospitalization rate ischemic heart disease accounting for 25% of (169.1 per 1,000) than females (134.4 per 1,000) these visits and other forms of heart disease (e.g. (Table 24). cardiac arrest, atrial fibrillation and flutter, heart In men, one fifth of the hospitalizations were due failure) accounting for another 42%. to circulatory disease with the major contributors When the emergency department visit rate is being ischemic heart disease (42%), heart failure calculated to reflect the number of individuals (13%), and cerebrovascular diseases (15%). as opposed to the number of visits (as it is shown in Table 23), the ED visit rate for seniors 75 years and older was 340.9 per Figure 50: Emergency department visits for 1,000 population in 2006 (males=350.2 per seniors 75+ years old by PHS area, 1,000; females=334.9 per 1,000). Among the Capital Health region, 2004-2006 combined seniors who went to the emergency Rate per 1,000 department in 2006, the average number of Capital Health region • 693.4 visits was 2.0 for males and 1.9 for females. St. Albert • 770.3

Castle Downs • 666.8

Table 23: Emergency department (ED) visits for Woodcroft • 637.6 males and females 75+ years old, Eastwood • 783.9 Capital Health region, 2006 North Central • 709.3 Leading causes by percent and (rank) North East • 802.9 Males Females Cause % (rank) % (rank) West Jasper Place • 618.3 Circulatory disease 12.8% (1) 12.3% (2) Twin Brooks • 507.3 Unintentional injury 11.5% (2) 16.4% (1) Bonnie Doon • 572.4 Respiratory disease 10.5% (3) 8.0% (4) Mill Woods • 610.5 Digestive disease 8.4% (4) 8.6% (3) Strathcona County • 545.5 Musculoskeletal/connective Leduc County 1,038.3 tissue diseases 4.9% (5) 6.8% (5) Westview 1,042.3 Males Females Sturgeon County 1,113.5 Number of ED visits 14,990 20,807 Fort Saskatchewan 1,279.8 Population (2006) 20,955 32,270 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy ED visit rate per 1,000 715.3 644.8 and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). (2) Population data values are for June 30. Values up to March 31, 2007 are

How healthy are we? / 2007 we? are healthy How Sources: (1) Clinical Accountability and Reporting Department, Operational Policy interpolations of actual population values from the Alberta Health Care Insurance and Integration Division, Capital Health (Health Care Utilization Data 2006). Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for (2) Population data values are for June 30, 2006 and are interpolated using actual points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File values and year-over-year population growth values provided by Registration File as of March 31, 2006 and 2007. the Health Surveillance Branch of Alberta Health and Wellness.

39 Table 24: Hospitalizations for males and females Figure 51: Hospitalizations for seniors 65-74 years old, Capital Health region, 2006 65-74 years old by PHS area, Leading causes by percent and (rank) Capital Health region, 2004-2006 combined Males Females Rate per 1,000 Cause % (rank) % (rank) Capital Health region • 154.3 Circulatory disease 21.2% (1) 12.8% (2) St. Albert • 145.8 Digestive disease 12.1% (2) 11.4% (4) Castle Downs • 138.0 Cancer 11.8% (3) 12.2% (3) Woodcroft • 171.8 Respiratory disease 11.0% (4) 10.2% (5) Eastwood • 189.3 Musculoskeletal/connective North Central • 144.1 tissue diseases 8.9% (5) 13.4% (1) North East • 160.6 Males Females West Jasper Place • 145.8 Number of hospitalizations 5,000 4,325 Twin Brooks • 128.9 Population (2006) 29,561 32,174 Bonnie Doon • 146.8 Hospitalization rate per 1,000 169.1 134.4 Mill Woods • 136.8 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2006). Strathcona County • 143.9 (2) Population data values are for June 30, 2006 and are interpolated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2006 and 2007. Leduc County • 185.2 Westview • 162.3

Sturgeon County • 195.9

For women, there was no one disease Fort Saskatchewan • 210.4 category that stood out but diseases of the Sources: (1) Clinical Accountability and Reporting Department, Operational Policy musculoskeletal system and connective tissue and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). accounted for the largest proportion of (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance hospitalizations in this age group. Within this Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP category, arthrosis (joint disorder) contributed Registration File values and year-over-year population growth values provided by to 68% of the musculoskeletal system-related the Health Surveillance Branch of Alberta Health and Wellness. hospitalizations. When the hospitalization rate is calculated to reflect the number of individuals as opposed circulatory disease with congestive heart to the number of hospitalizations (as it is failure contributing to one quarter of these shown in Table 24), the hospitalization rate for hospitalizations (Table 25). While unintentional seniors aged 65-74 years was 110.1 per 1,000 injury ranked second for women, respiratory population in 2006 (males=120.5 per 1,000; disease ranked second for men. females=100.6 per 1,000). Among the seniors When the hospitalization rate is calculated to who were hospitalized in 2006, the average reflect the number of individuals as opposed to number of hospitalizations was 1.4 for males the number of hospitalizations (as it is shown in and 1.3 for females. Table 25), the hospitalization rate for seniors 75 Hospitalizations by PHS area years and older was 197.1 per 1,000 population in 2006 (males=214.2 per 1,000; females=185.9 The regional hospitalization rate for seniors per 1,000). Among the adults that were between 65 and 74 years was 154.3 per 1,000 hospitalized in 2006, the average number of (Figure 51). Significantly higher rates were hospitalizations was 1.4 for both males and observed in Woodcroft, Eastwood, Leduc females. County, Sturgeon County, and Fort Saskatchewan. Hospitalizations by PHS area The hospitalization rates for Leduc County, 75+ YEAR OLDS How healthy are we? / 2007 we? are healthy How Sturgeon County and Fort Saskatchewan are For seniors aged 75 years and older, the significantly higher than the regional rate and number one reason for hospitalization was higher than the rates in the other public health

40 Table 25: Hospitalizations for males and females Figure 52: Hospitalizations for seniors 75+ years old, Capital Health region, 2006 75+ years old by PHS area, Leading causes by percent and (rank) Capital Health region, 2004-2006 combined Males Females Rate per 1,000 Cause % (rank) % (rank) Capital Health region • 286.7 Circulatory disease 20.6% (1) 17.2% (1) St. Albert • 282.0 Respiratory disease 13.4% (2) 10.5% (4) Castle Downs • 275.2 Digestive disease 11.1% (3) 10.7% (3) Woodcroft • 272.0 Cancer 8.9% (4) 6.5% Eastwood • 331.8 Musculoskeletal/connective North Central • 264.6 tissue diseases 6.2% (5) 8.3% (5) North East • 282.7 Unintentional injury 5.4% 11.2% (2) West Jasper Place • 255.0 Males Females Twin Brooks • 247.2 Number of hospitalizations 6,413 8,381 Bonnie Doon • 278.4 Population (2006) 20,955 32.270 Mill Woods • 267.6 Hospitalization rate per 1,000 306.0 259.7 Strathcona County • 283.4 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2006). Leduc County • 413.3 (2) Population data values are for June 30, 2006 and are interpolated using actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31, 2006 and 2007. Westview • 308.8 Sturgeon County • 421.6

Fort Saskatchewan • 429.0 service areas (Figure 52). Eastwood was the Sources: (1) Clinical Accountability and Reporting Department, Operational Policy and Integration Division, Capital Health (Health Care Utilization Data 2004-2006). only public health service area within the City (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance of Edmonton with a significantly higher Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for hospitalization rate than the region. points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over-year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness. Why do seniors die?

65-74 YEAR OLDS Figure 53: Leading causes of death for Seniors between 65 and 74 years of age died 65-74 year olds, Capital Health region, 2006 primarily from cancer or circulatory disease I Male deaths = 648 I Female deaths = 429 (Figure 53). For women, almost half of the By percent deaths (48%) were due to cancer and approximately one quarter were due to Cancer 36.3 48.0 circulatory disease. For men in this age group, cancer and circulatory disease each Circulatory disease 35.6 23.8 contributed about the same percentage of deaths (36%). Respiratory disease 8.6 6.3 The mortality rate, from all causes, (10 years of Digestive disease 6.0 data combined) for seniors aged 65-74 years was 5.4 1,813.8 per 100,000 (Figure 54). Significantly higher rates were found in Woodcroft and Endocrine/nutritional/ 3.1 metabolic diseases 3.3 Eastwood. Nervous system 2.8 disease 5.4 75+ YEAR OLDS All other causes 7.6 For older seniors, those 75 years of age and older, 7.9 How healthy are we? / 2007 we? are healthy How circulatory disease caused the most deaths for Source: Vital Statistics (Death Data), 2006. both males and females (Figure 55). For females in this age group, 18.7% of deaths were due to

41 Figure 54: Mortality rate for seniors Figure 55: Leading causes of death for 65-74 years old by PHS area, 75+ year olds, Capital Health region, 2006 Capital Health region, 1997-2006 combined I Male deaths = 1,518 I Female deaths = 1,873 Rate per 100,000 By percent Capital Health region • 1,813.8 Circulatory disease 37.0 39.9 St. Albert • 1,570.0 Cancer 25.7 Castle Downs • 1,551.9 18.7 Woodcroft • 2,161.5 Respiratory disease 13.8 Eastwood • 2,408.9 11.0

North Central • 1,732.4 Mental disorders 5.0 7.6 North East • 1,976.8 Nervous system 4.2 West Jasper Place • 1,785.8 disease 5.7

Twin Brooks • 1,444.3 Digestive disease 3.0 4.2 Bonnie Doon • 1,768.1 All other causes 11.3 Mill Woods • 1,536.6 12.8

Strathcona County • 1,486.8 Source: Vital Statistics (Death Data), 2006.

Leduc County • 1,662.1

Westview • 1,962.7

Sturgeon County • 1,799.8 Figure 56: Mortality rate for seniors 75-84 years old by PHS area, Fort Saskatchewan • 2,201.3 Capital Health region, 1997-2006 combined Sources: (1) Vital Statistics (Death Data), 1997-2006. (2) Population data values are Rate per 100,000 for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of Capital Health region • 4,574.3 March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over- St. Albert • 4,731.2 year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness. Castle Downs • 3,667.1

Woodcroft • 4,657.9

cancer. This is a marked decline from the 48% of Eastwood • 4,435.2 female deaths that were caused by cancer in the younger seniors (65-74 years of age). North Central • 4,801.8 The mortality rates, from all causes, for seniors North East • 4,538.0 aged 75-84 years and those aged 85+ years are West Jasper Place • 4,395.8 shown. For the seniors between 75-84 years of Twin Brooks • 4,326.8 age, there was very little variation in the Bonnie Doon • 4,500.9 mortality rate within the Capital Health region (Figure 56). Mill Woods • 4,465.8 The only rate that was significantly higher than Strathcona County • 4,692.4 the regional rate was in Fort Saskatchewan Leduc County • 4,583.4 (5,412.2 per 100,000) and the only rate that was Westview • 4,753.9 significantly lower was in Castle Downs (3,667.1 per 100,000). Sturgeon County • 4,826.2 For seniors aged 85 years and older, there was Fort Saskatchewan • 5,412.2 more variation in the mortality rate with North Sources: (1) Vital Statistics (Death Data), 1997-2006. (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population Central (Figure 57), Twin Brooks, and Strathcona values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of County having significantly higher rates than the March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over- region. Significantly lower mortality rates were year population growth values provided by the Health Surveillance Branch of How healthy are we? / 2007 we? are healthy How observed in Castle Downs, Woodcroft, Eastwood, Alberta Health and Wellness. and Bonnie Doon.

42 Figure 57: Mortality rate for seniors 85+ years old by PHS area, Capital Health region, 1997-2006 combined Rate per 100,000 Capital Health region • 13,710.4

St. Albert • 14,858.1

Castle Downs • 11,866.5

Woodcroft • 11,580.6

Eastwood • 10,237.8

North Central • 15,366.3

North East • 13,258.0

West Jasper Place • 14,395.4

Twin Brooks • 16,449.4

Bonnie Doon • 12,983.9

Mill Woods • 14,923.8

Strathcona County • 15,515.4

Leduc County • 14,942.6

Westview • 14,692.3

Sturgeon County • 13,073.4

Fort Saskatchewan • 14,192.4

Sources: (1) Vital Statistics (Death Data), 1997-2006. (2) Population data values are for June 30. Values up to March 31, 2007 are interpolations of actual population values from the Alberta Health Care Insurance Plan (AHCIP) Registration File as of March 31 for each year. Forecast values for points in time after March 31, 2007 are estimated using the March 31, 2007 AHCIP Registration File values and year-over- year population growth values provided by the Health Surveillance Branch of Alberta Health and Wellness. How healthy are we? / 2007 we? are healthy How

43 Urban sprawl and population heath

Land-use planning affects our health. Whether (1) physical inactivity; we live in Edmonton’s core neighbourhoods, (2) air pollution; suburbs, other municipalities, or a rural area in the Capital Health region, our health is affected (3) motor vehicle collisions; and by the way land is developed and how (4) mental health.1 buildings and infrastructure are constructed. Figure 58 shows how these health risks are Many determinants of health in the Capital related conceptually to sprawl, and where Health region are affected by our land use evidence of causal connections is emerging. patterns and priorities such as: G The amount, density, location, and What is sprawl? affordability of housing Urban sprawl is an uncoordinated pattern of G Population density land development on previously undeveloped land – greenfields – at the edges of an urban G The location and mix of residential, area. While there is no consensus definition, commercial, industrial, and agricultural land the following description of sprawl is useful: G Transportation options “Continuous low-density residential G Access to nutritious food development on the metropolitan fringe, G Distance to work, shopping, natural areas, ribbon low-density development along major and public places suburban highways, and [or] development that leapfrogs past undeveloped land to leave G Physical safety of roads, trails, and walkways a patchwork of developed and undeveloped G Opportunities for physical activity tracts.”2 G Air quality One key feature of sprawl is that it supports G Perceptions of neighbourhood safety automobile transportation as the main mode G Social interaction of travel, and often makes other forms of transit, such as riding the bus or train, walking, G Crime or cycling, inefficient, costly, and/or unsafe. G Access to healthcare and health promotion Sprawl is very common in North American resources cities, including Edmonton and Calgary, where In this section, we focus on the health the land available for outward expansion is implications of urban sprawl. Sprawl has perceived to be plentiful. The low population characterized much of the growth in the Capital density of sprawling areas also indicates an Health region in the past several decades. We’ll automobile-focused transportation consider four major categories of health risks infrastructure. The Edmonton Census How healthy are we? / 2007 we? are healthy How associated with sprawl: Metropolitan area (CMA), which corresponds

44 Figure 58: Impacts of sprawl on the health of the population in the Capital Health region Elements of sprawl k Population health risks k Health outcomes (examples)

G Heart disease G Diabetes Low density development Physical inactivity k G Colon cancer k G Osteoporosis G Respiratory disorders Separation of residential Reduced air quality G Heart disease and commercial areas k k G Some cancer types G Development on greenfields Motor vehicle collisions k Fatal injury at edges of urban areas k G Non-fatal injury Transportation infrastructure Social isolation Loss of natural areas G Mental health impacts biased towards automobiles k Commuting stress

Source: Prepared by Population Health, Population Health and Research, Capital Health, 2008.

to the Capital Health region minus the western Sprawl in the Capital Health region edge of Westview, has the lowest population In the Capital Health region, sprawl has density of the eight largest metro areas in characterized growth for several decades. The . Based on recent Statistics Canada dark purple areas in the Edmonton CMA map data, Edmonton CMA is also the most on page 46 (Figure 59) are the areas of fastest auto-dependent of these areas (Table 26). population growth between 2001 and 2006. These areas are predominantly at the edges of the city. Table 26: Population densities and automobile From 1982 through 2001, the population in dependence in major Canadian metropolitan Edmonton’s core neighbourhoods hovered areas around 350,000. Over the same time period, Percent of the suburban population – the population at population aged the edges of the city – increased from 180,000 18 years and older to more than 325,000.4 Figure 60 shows how Census Population making all trips this pattern developed from the mid-70s Metropolitan Density by car (as driver Area (CMA) (persons/km2) or passenger) through to the present. Edmonton 109.9 77 The population of the Capital Health region continues to grow. Edmonton’s suburbs and Winnipeg 131.0 72 parts of its downtown, as well as several other Ottawa-Gatineau 197.8 71 municipalities in the Edmonton CMA are Calgary 211.3 75 growing. Estimates by Alberta Health and Quebec City 218.4 74 Wellness for the City of Edmonton alone Vancouver 735.6 69 indicate an additional 200,000 people over the next 20-25 years. To house, employ, transport, Montreal 853.6 65 and provide services for this growing Toronto 866.1 66 population, many land-use decisions will be

Source: Statistics Canada, 20083 made. These decisions have the potential for positive and negative influences. How healthy are we? / 2007 we? are healthy How

45 Figure 59: Edmonton CMA, population change, 2001-2006 by 2006 Census Tract (CT)

Source: 2001 and 2006 Censuses of Canada. Produced by the Geography Division, Statistics Canada, 2007. ttp://www12.statcan.ca/english/census06/analysis/popdwell/tables.cfm

Figure 60: Edmonton inner city and suburban Sprawl and physical inactivity population growth, 1976-2005 There are strong links between physical activity Number of residents and health. Physical inactivity, or simply not being N Edmonton inner city N Edmonton suburbs active on a regular basis, can affect lung function, the cardiovascular system, immune system 50,000 function, and the strength and resilience of bones 40,000 and muscles.6 Physical inactivity also increases the risk for obesity, which in turn contributes to the 30,000 development of many chronic diseases including 20,000 heart disease, diabetes, colorectal cancer, and chronic obstructive pulmonary disease.7 About 10,000 half of us in the Capital Health region do not get 0 enough physical activity to obtain health benefits.8 We can be inactive for various reasons, including: 1976 1982 1986 1989 1991 1993 1999 2001 2005 How healthy are we? / 2007 we? are healthy How G Lack of resources such as time and money to Source: City of Edmonton, 20065 participate in forms of activity that require facilities (e.g., gyms) or in structured

46 programs that require equipment and fees Neighbourhood ACTIVE TRANSIT: (e.g., organized ice hockey) features such as Active forms of transit G Lack of social support high street involve physical activity, connectivity, and include walking G Fears about neighbourhood safety relatively high (including walking to or G Sedentary work population density, from a bus or train G Injury or disability and mixed land use stop) and cycling. (e.g., residential and One of the factors that supports or discourages commercial) have been physical activity for the whole population is linked to increased land use.9 Low population density development physical activity.5 By creating such as sprawl, and transportation efficient and uncomplicated pedestrian infrastructure that emphasizes automobile routes to bus or train stops, well connected travel, increase time spent commuting and streets may also increase the use of public transit. decrease daily opportunities for widely The connectivity of streets in the neighbourhood accessible and inexpensive forms of exercise in Figure 62a, which is more typical of core urban such as walking or biking. Walking to work or neighbourhoods, shows how walking can be an shopping areas, sending children to the corner efficient means of getting to a daily destination store or to school on their bicycles, or traveling such as a school. The neighbourhood in Figure to other destinations by bus or train, are made 62b contains the long blocks and limited access more difficult and/or dangerous when streets points of some of the low-density are not well-connected, when distances are neighbourhoods in the Capital Health region great, or when public transit is undersupplied which are not conducive to walking as a means of because population density is insufficient to getting to and from daily destinations. support regular service. Sprawl that emphasizes automobile transit is also In the Capital Health region, motor vehicle biased towards those who can afford to buy and transportation is chosen much more often than maintain cars, and who are able and permitted to other transit modes. Figure 61 compares the drive. Those who do not have a car or who are not ways in which people get to work in the able or permitted to drive encounter a narrowed Edmonton CMA. The vast majority drove a range of employment and activity options, as well motor vehicle or rode as a passenger in one. as reduced access to a variety of basic material, It is the strong connection between sprawl and social, and healthcare resources. widespread motor vehicle use that is most If the Capital Health region continues to grow concerning for physical inactivity in the region. along “business-as-usual” lines, with most new Time spent driving is time not spent in active development being located on previously transit such as walking and cycling – or in other types of activities.

Figure 62: Street Connectivity

Figure 61: Mode of transportation to work, Edmonton Metropolitan Area (CMA), 2006 By population Car, truck, van, as driver 409,650 Car, truck, van, as passenger 1 42,740 Public transit 1 52,995 Walked or bicycled 1 34,050 All other modes 6,630 Figure 62a: Many options Figure 62b: Few options How healthy are we? / 2007 we? are healthy How Source: Statistics Canada, 2006 Federal Census data for Edmonton CMA. Source: Neighborhood Streets Project Stakeholders. Neighborhood street design http://www12.statcan.ca/english/census06/data/profiles/community/Details/ guidelines: an Oregon guide for reducing street widths. Salem, Oregon: Page.cfm?Lang=E&Geo1=CMA&Code1=835__&Geo2=PR&Code2=48&Data=Count& Neighborhood Streets Project Stakeholders; November 2000. Available from: URL: SearchText=edmonton&SearchType=Begins&SearchPR=48&B1=All&Custom= http://www.lcd.state.or.us/LCD/docs/publications/neighstreet.pdf

47 undeveloped land at the edges of Edmonton, it Children living by, or attending school is likely that people will continue to have to rely near high-traffic roadways have reduced heavily on automobiles for most of their lung-function growth or poorer transportation needs, and choices for more respiratory health than children active transit will be constrained. All of the living or attending school municipalities in the Capital Health region are further from major roads.14,15 facing important choices about how they will grow in the years ahead – choices that will affect the level of physical inactivity in the region. but it is clearly an important one; the number of Sprawl and air pollution vehicles traveling to and from the city from outlying areas increased by about 75% in the The air we breathe is a fundamental necessity past 20 years. of life, and there is an abundance of evidence linking air pollution to increased rates of illness In the Capital Health region, limited data are and death in populations.12,13 With industrial available. A 2006 study on the relationship growth, a growing population, and our reliance between outdoor air pollution and emergency on private motor vehicles that characterize department visits for asthma in the Edmonton sprawl, air pollution will increase. metro area concluded that exposure to ambient levels of air pollution (including pollutants In Canadian cities, including Edmonton, vehicle present in vehicle exhaust, such as NO , CO, emissions are an important determinant of local 2 and particulate matter) is an important air quality and its related health impacts. Links determinant of emergency department visits between air pollution and health, and the for asthma, particularly among young children contribution of vehicle exhaust to local and and the elderly.17 regional air quality, are widely recognized. However, advancements in fields such as One way of assessing the level of health risk toxicology and environmental science, and posed by air pollution is through the use of air results from epidemiological investigations, quality indicators that reflect measurements have improved our understanding of which taken at monitoring stations, and which pollutants pose the greatest risks to humans, correspond to observed increases in and which subpopulations, such as children and hospitalizations or deaths in the days following those with existing respiratory problems, are measurements of high pollution. According to more vulnerable. We also know that pollutants Alberta Environment, there were six days in can have additive or synergistic effects, Edmonton ranked by the air quality index (AQI) contributing more of a health “punch” together currently in use in Alberta as “poor/very poor” than they would independently. in 2007. The air quality index reflects contributions from vehicular and non-vehicular Common air pollutants that pose risks for sources. human health include sulfur oxides, nitrogen oxides and fine particulate matter – However, Alberta’s AQI has theoretical microscopic by-products of combustion that limitations and its interpretation around health can be breathed into the lungs and absorbed impacts is not clear. The Government of Canada into the bloodstream. All of these pollutants are has recently developed the Air Quality Health constituents of vehicle exhaust. Index (AQHI), which better reflects the current state of knowledge about how air pollution Regional air pollution from vehicle exhaust has affects health.18 Use of the AQHI in Alberta been linked to premature deaths and illness. A could enable more accurate assessment of the report released last year by the Toronto Public relationship between air pollution and health, Health District estimated that in the Toronto and would help us to estimate how much illness area more than 400 premature deaths each and premature death in the Capital Health year could be avoided by eliminating the region is attributable to our extensive use of pollution caused by vehicle exhaust.16 A

How healthy are we? / 2007 we? are healthy How motor vehicles. sprawling land use pattern that promotes car travel is not the only contributing factor to It is also important to distinguish the time Toronto’s vehicular emissions and air quality, scales over which common air pollutants

48 Figure 63: Long-term trend in nitrogen dioxide Table 27: Emergency department visits, (NO2 ) levels, Capital Health region, 1998-2006 hospitalizations, and deaths from injury for Concentration (ppm) residents, Capital Health region, 2006 N Edmonton Central N Calgary Central Injury from G Edmonton East G Calgary East motor vehicle I Edmonton Northwest I Calgary Northwest All causes collisions in of injury traffic 0.035 (Number of (Number of 0.030 Event events) events and %) Emergency 0.025 Department Visits 106,040 7,451 (7.0%) 0.020 Hospitalizations 7,760 625 (8.1%) Deaths 484 67 (13.8%) 0.015 Sources: (1) Clinical Accountability and Reporting Department, Operational Policy 0.010 and Integration Division, Capital Health. (2) Vital Statistics (Death Data), 2006.

0.005 Residents of the Capital Health region travel 0.000 consistently and most often by motor vehicle. Transportation survey results indicate that more

1998 1999 2000 2001 2002 2003 2004 2005 2006 than three-quarters of our daily local trips are in Source: Clean Air Strategic Alliance (CASA) Data Warehouse, 2008 motor vehicles. Active transit modes account for only about 2% of trips in the Capital Health impact the health of the population in our region, and a somewhat larger proportion in the region. For example, Figure 63, based on Edmonton area specifically.19 Motor vehicles monitoring data from stations in Edmonton and dominate the transportation landscape, and Calgary, shows a slight improvement over the injuries and injury-related deaths from motor past several years in the average annual vehicle crashes are a key public health concern. concentration of NO2, a common emission from motor vehicles. However, this long term trend In 2006, 67 residents of the region died in does not reflect important variation within motor vehicle-related events on public individual years, weeks, and days of the period roadways (including collisions involving of analysis, and it does not capture important pedestrians and pedal cyclists). Fourteen of additive or synergistic effects of pollutants, as these fatalities occurred on roads outside of the mentioned above. region. Injuries involving motor vehicles on public roadways were responsible for 8.1% of Finally, air quality gains from cleaner hospitalizations due to injury and about 7.0% of combustion processes and government emergency department visits due to injury regulation of industrial emissions will likely be (Table 27). lost if our growth in population, consumption, and automobile-focused urban growth For Albertans aged 0-19 years, serious injurious continues. The way that we use land in the events involving motor vehicles make up over Capital Health region, and the types of half of the major trauma burden. Figure 64 transportation that we support by our land-use shows how this proportion decisions, will positively or negatively influence compares with other our health through changes to the quality of important causes of the air that we breathe. major trauma in this age group. Although Sprawl and motor vehicle collisions the rate of “Almost fifty percent traumatic injury of all child and teen Motor vehicles are a central part of our culture, to children from major trauma cases occur and most of us have trouble imagining life motor vehicle at a street location without them. According to Alberta collisions is (includes highways, How healthy are we? / 2007 we? are healthy How Transportation, in the Capital Health region lower in the roadways, sidewalks, there are now more registered motor vehicles Capital Health curbs, freeways, and than there are licensed drivers. motorways).” 20

49 Figure 64: Leading causes of unintentional “In general, compact cities major trauma, 0-19 years of age, Alberta, with more extensive public 2002-2003 transit systems have lower automobile fatality rates (including drivers and 47% Motor vehicle, traffic passengers, but excluding pedestrians) 9% Motor vehicle, non-traffic than more sprawling cities.”1 2% Pedal cycles 19% Falls 7% Homicide and assault 3% Child abuse 3% Struck by object (e.g., sports) 10% Other transit, are low priorities when the built environment is oriented towards motor vehicle Source: Holgate K, Phillips L. Alberta child & teen major trauma report. Edmonton, Alberta: Kidsafe Connection – Stollery Children’s Hospital; 2006. transportation. Changes in our land-use, and in our transportation culture and infrastructure are region than in the province as a whole, the needed. Comparable Canadian data need to be proportion of traumatic injury due to motor developed. Data from US cities, show profound vehicle collisions in traffic is almost identical. differences in the rates of traffic-related By requiring extensive road and highway mortality between compactly developed urban infrastructure, and promoting automobile travel, areas (“Smartest Growth”) and sprawling urban sprawl contributes to the motor vehicle areas (“Most Sprawled”) (Figure 66). collisions that result in injuries and fatalities in the Capital Health region. People who live in sprawling neighbourhoods drive more than those living in more compact neighbourhoods, Figure 65: Proportion of workers with a round and are therefore at greater risk for injurious trip commute of 60 minutes or more by region of collisions.21 Among major Canadian urban areas, residence, Canada, 1992, 1998, 2005 between 1992 and 2005 Edmonton showed the I 1992 I 1998 I 2005

greatest percentage point increase in the To ro n to 51% proportion of workers with a round trip 67% commute of 60 minutes or more (Figure 65).3 66% Commute times increased both for those who Montreal 47% commute by private automobiles and for those 53% who use public transit. 60% Many of the destinations common in sprawling Vancouver 58% 58% neighbourhoods, such as “big box” stores and 55% large supermarkets, are built for automobile Ottawa-Gatineau 48% access. Sidewalks and bike lanes of sufficient 48% quantity and quality, as well as efficient public 55%

Calgary 36% 54% 57%

Edmonton 31% 50% Smart Growth: 53%

“Smart growth” is a collection of Other CMA/CA 26% land-use principles and practices 31% emphasizing active transit and pedestrian 36% access to regular destinations, a greater Non CMA/rural 28% How healthy are we? / 2007 we? are healthy How mix of housing, commercial and retail uses, 35% and the preservation of green spaces and 40% other environmental features. Source: Statistics Canada (General Social Survey, 1992, 1998, 2005)21

50 Figure 66: Traffic-related deaths, “smart growth” factors contributing to mental health are cities and sprawling cities, United States, 2000 numerous and operate at multiple levels, connections between sprawl and mental health I Smartest growth I Most sprawled are less clear than connections between sprawl Per 100,000 population and physical health.22 New York City, NY 4.42 Social isolation is a well established risk for Kings County, NY 4.46 mental illness.23 Sprawl may affect mental Bronx County, NY 4.20 health by contributing to the isolation of Queens County, NY 4.58 individuals and thus reducing the quality of San Francisco County, CA 6.31 interpersonal relationships and the frequency of supportive social contact. Low-density Hudson County, NJ 5.91 development with little mixing of residential, Philadelphia County, PA 8.04 commercial, and public space may contribute Suffolk County, MA 4.49 to social isolation, especially for those without Richmond County, NY 5.63 ready access to an automobile and/or those who face cultural, physical, or economic Baltimore City, MD 7.68 7.68 barriers to social integration. Isolated Stokes County, NC 15.66 individuals have limited opportunities to Miami County, KS 38.80 develop and experience interpersonal trust and Davie County, NC 25.84 to engage in practices of reciprocity – both of which are related to positive mental health.24 Island County, MN 12.78 Walton County, GA 19.77 Another way that sprawl may affect mental well-being is through its impact on the Yadkin County, NC 38.52 relationship between humans and the natural Goochland County, VA 35.58 world. Because sprawl is almost always Fulton County, OH 28.01 associated with development of previously Clinton County, MI 16.99 undeveloped or agricultural land, natural space is lost. Sprawling developments that exclude Geauga County, OH 20.9 biologically diverse and productive areas can Source: Ewing, Scheiber, and Zegeer, 200322 be detrimental to individual and community well-being. Incorporating natural areas into development both in the urban core and at the Sprawl and mental health periphery of the city may reduce the negative The previous sections have looked at how impacts of sprawl on sprawl affects air pollution, injury and death mental health and on from motor vehicle collisions, and physical less tangible but People living in inactivity – all important population health critical social buildings surrounded concerns in the Capital Health region, and all of resources such as by greenspace had a which will be affected by how the region grows bonds of trust stronger sense of in the years ahead. and practices of community, better In this section, we touch on how sprawl reciprocity. relationships with contributes to mental health. Mental health neighbours, and less Sprawling encompasses debilitating conditions such as heated domestic development major depression, generalized anxiety disorder, conflicts than those generally places and schizophrenia, as well as acute and chronic not surrounded greater per capita forms of mental/emotional suffering which are by greenspace.25 resource demands neither diagnosed nor treated. on municipal Mental health problems are highly government services underreported and are also related to a variety than more compact forms of

How healthy are we? / 2007 we? are healthy How of chronic conditions. This means that the development closer to urban extent of suffering from mental distress is centres. This may have the effect of dramatically under-estimated. Because the contributing to greater health risks in inner city

51 “The cost to provide public services and infrastructure in new sprawling development is higher than the cost to service that same population in a more compact development form.”27

neighbourhoods, as municipal resources required for infrastructure development and maintenance, law enforcement, and even public health and health care services are spread over an increasingly larger area of land. These displaced resources could be used to support affordable housing, reliable and safe public and active-transit transportation infrastructure, and attractive public spaces to play and meet in neighbourhoods currently lacking these elements. These basic resources help reduce social decay and support mental health.26 The Ontario College of Family Physicians sums up current thinking about the effects of sprawl on mental health: “Sprawl impacts negatively on well-being by eroding social capital, robbing people of all ages of the opportunity to have a balanced healthy lifestyle, degrading the surrounding natural environment, and increasing the stress of commuting, which not only impacts mental health but also physical health.” 28 Sprawl is an important public health issue in the Capital Health region, but many of the forces that lead to sprawl and perpetuate it are outside the direct influence of Capital Health. Political will and the collaborative efforts of diverse stakeholders – including an active citizenry – are needed to ensure that growth patterns in the region promote health rather than exacerbate existing health problems such as physical inactivity and injury and death from motor vehicle collisions. Many municipalities in the Capital Health region are in the process of revising their land-use plans. Check with your municipal government’s planning department to see whether existing land-use plans and strategies take population health concerns into account. How healthy are we? / 2007 we? are healthy How

52 References for urban sprawl and population health

1 Johnson SA, Marko J. Designing healthy places: March 13, 2007). Ottawa, Ontario: Statistics Canada. land use planning and public health. Edmonton, Available: http://www12.statcan.ca/english/census Alberta: Population Health - Capital Health; 2007. 06/data/profiles/community/Index.cfm?Lang=E. 2 Altshuler A, Gomez-Ibanez JA. Regulation for 11 Saelens BE, Sallis JF, Black JB, Black BA, Chen BA. revenue: the political economy of land use Neighborhood-based differences in physical exactions. Washington, DC: Brookings Institution; activity: an environment scale evaluation. American 1993. Journal of Public Health 2003 93(9): 1552-1558. 3 Turcotte M. Dependence on cars in urban 12 World Health Organization. Health aspects of air neighbourhoods. Ottawa, Ontario: Statistics pollution: results from the WHO project “Systematic Canada;2008. Available from URL: review of health aspects of air pollution in Europe. http://www.statcan.ca/english/freepub/11-008- Denmark: WHO Regional Office for Europe; 2004. XIE/2008001/article/10503-en.htm. 13 Toronto Public Health. Toronto air quality index: 4 City of Edmonton Census. Edmonton, Alberta: City health links analysis. Toronto, Ontario: Toronto of Edmonton; (various years). Public Health; 2001. 5 City of Edmonton Planning and Development. 14 Brunekreef B, Janssen NA, de Hartog J, Monthly Economic Review. Edmonton: City of Harssema H, Knape M, van Vliet P. Air pollution Edmonton; February 2006. Available from URL: from truck traffic and lung function in children http://www.edmonton.ca/portal/server.pt/gateway/ living near motorways. Epidemiology 1997;8:298- PTARGS_0_0_379_214_0_43/http%3B/CMSServer 303. /COEWeb/infrastructure+planning+and+building/ 15 Janssen NA, Brunekreef B, van Vliet P, et al. The economic+information/Monthly+Economic+Review. relationship between air pollution from heavy traffic htm. and allergic sensitization, bronchial hyper- 6 Magnusson P, Torp-Pedersen CT, Backer V, Beyer N, responsiveness, and respiratory symptoms in Dutch Andersen LB, Hansen I-LK et al. 2004. Physical schoolchildren. Environmental Health activity and chronic disease: epidemiology, Perspectives 2003;111:1512-1518. biological mechanisms, practical recommendations 16 McKeown D. Air pollution burden of illness from and future research. III: the musculoskeletal system traffic in Toronto: problems and solutions. Toronto, and the lungs. Ugeskrift for Laeger Ontario: Toronto Public Health; 2007. 2004;166(17):1552-1557. 17 Villeneuve PJ, Chen L, Rowe BH, Coates F. Outdoor 7 United States Department of Health and Human air pollution and emergency department visits for Services. The Surgeon General’s call to action to asthma among children and adults: a case- prevent and decrease overweight and obesity. crossover study in northern Alberta, Canada. Rockville, MD: United States Department of Health Environmental Health: A Global Access Science and Human Services, Public Health Service, Office Source 2007; 6 (Article number 40). of the Surgeon General; 2001. 18 Stieb DM, Smith-Doiron M, Brion O, Economou V, 8 Population Research Shin HH, Burnett RT. A new multi-pollutant, no Laboratory (2007) Alberta survey. Edmonton, threshold air quality and health index based on the Alberta: University of Alberta; 2007. short-term association of air pollution and mortality. 9 Gebel K, King L, Bauman A, Vita P, Gill T, Rigby A, Ottawa, Ontario: Health Canada; 2006. Capon A. Creating healthy environments: a review 19 City of Edmonton. Edmonton household travel of links between the physical environment, physical survey; 2005. Available from URL: activity, and obesity. Sydney: NSW Health http://www.edmonton.ca/portal/server.pt/gateway/ Department and NSW Centre for Overweight and PTARGS_0_0_265_210_0_43/http%3B/CMSServer Obesity; 2005. /COEWeb/roads+and+traffic/plans+and+initiatives/ How healthy are we? / 2007 we? are healthy How 10 Statistics Canada. 2007. Edmonton, Alberta (table). 2005+Edmonton+Household+Travel+Survey.htm. 2006 Community Profiles. (2006 Census; released

53 20 Holgate K, Phillips L. Alberta child & teen major trauma report. Edmonton, Alberta: Kidsafe Connection – Stollery Children’s Hospital; 2006. 21 Sightline Institute. Cascadia Scorecard. Seattle, Washington: Sightline Institute; 2006. 22 Ewing R, Schieber RA, Zegeer CV. Urban sprawl as a risk factor in motor vehicle occupant and pedestrian fatalities. American Journal of Public Health 2003; 93(9):1541-1545. 23 Sturm R, Cohen DA. Suburban sprawl and physical and mental health. Public Health 2004;118(7):488- 496. 24 Berkman LF. The role of social relations in health promotion. Psychosomatic Medicine 1995; 57:245- 254. 25 Kuo F, Sullivan W. Environment and crime in the inner city: does vegetation reduce crime? Environment and Behaviour 2001; 33:343-367. 26 Ross CE. Neighbourhood disadvantage and adult depression. Journal of Health and Social Behavior 2000; 41:177-187. 27 Burchell RW. Sprawl costs: economic impacts of unchecked development. Washington DC: Island Press; 2005. 28Ontario College of Family Physicians. The health impacts of urban sprawl: social and mental health. Toronto: Ontario College of Family Physicians; 2005. How healthy are we? / 2007 we? are healthy How

54 Data notes

ICD10 codes use for mortality, hospitalization, and emergency department visits Disease ICD10 Codes Certain infectious and parasitic disease A00 - B99 Cancer C00 - C97 Breast (female) C50 Colorectal C18 - C21 Lung C33 - C34 Prostate C61 Benign tumor, pre/non-invasive or uncertain cancer D00 - D48 Blood or blood forming organ disease D50, D89.9 Endocrine/metabolic disorders E00 - E90 Mental disorders F00 - F99 Nervous/sense organ disease G00 - G99, H00 - H59, H60 - H95 Circulatory disease I 00 - I 99 Heart disease I 00 - I 09, I 11, I 13, I 20 - I 51 Stroke I 60 - I 69 Respiratory disease J00 - J99 Digestive disease K00 - K93 Musculoskeletal disease M00 - M99 Genitourinary system disease N00 - N99 Certain perinatal related conditions P00 - P96 All injury V01 - Y98 Unintentional injury V01 - V99, W00 - W99, X00 - X59, Y85 - Y86 Intentional injury X60 - X99, Y00 - Y09, Y35 - Y36, Y87 - Y87.1, Y89 - Y89.1 Injury (undetermined intent) Y10 - Y34, Y89.9, Y87.2 Land transport injury (including motor vehicle) V01 - V89 Falls W00 - W19 Suicide X60 - X84 How healthy are we? / 2007 we? are healthy How

55 Keeping you informed

At Capital Health, we regularly track trends For more information and resources… and assess the impact of a number of factors on the health of people in the region. We HELPFUL PHONE NUMBERS hope reports like this provide useful and interesting information for people and act as Capital Health LINK a catalyst for action. Health advice and information Open 24 hours a day, 7 days a week If you have questions about the information 780-408-LINK (5465) or issues in this report or have other Toll free in Alberta 1-866-408-LINK (5465) questions about the health of people in the region, please give us a call. Distress/Suicide Line Open 24 hours a day, 7 days a week 780-482-4357 Contact: Information and Referral Line Medical Officer of Health Open 24 hours a day, 7 days a week Suite 300, 10216 – 124 Street 211 or 780-482-INFO (4636) Edmonton, Alberta T5N 4A3 Phone: (780) 413-7946 Alberta Health and Wellness Registration/Claims/Billings/Inquires 780-427-1432

HELPFUL WEB SITES

Capital Health www.capitalhealth.ca Health Canada www.hc-sc.gc.ca Canadian Health Network www.canadian-health-network.ca Health in Action (Alberta) www.health-in-action.org Alberta Mental Health Board www.amhb.ab.ca The Support Network www.thesupportnetwork.com Heart and Stroke Foundation of Canada ww2.heartandstroke.ca Dietitians of Canada For nutrition and BMI information www.dietitians.ca Alberta Alcohol and Drug Abuse Commission (AADAC) www.aadac.com Canadian Institute for Health Information www.cihi.ca How healthy are we? / 2007 we? are healthy How Statistics Canada www.statcan.ca

56 RESOURCES FOR INFORMATION AND SUGGESTED CITATION ACTION RELATED TO URBAN SPRAWL Predy GN, Fraser-Lee N, Ladd B, Brown A, AND POPULATION HEALTH Edwards J, Lightfoot P. How healthy are we? Johnson SA, Marko J. 2007 A report of the Medical Officer of Health. Designing healthy places: land use planning Edmonton, Alberta: Public Health Division, and public health. Capital Health; (June, 2008). Edmonton, Alberta: Population Health – Capital Health; 2007. www.capitalhealth.ca/AboutUs/Resource Library/Other/default.htm Ontario College of Family Physicians Report on public health and urban sprawl in Ontario. Environmental Health Committee, Ontario College of Family Physicians; 2005. www.ocfp.on.ca/English/OCFP/Urban-Sprawl/ Victoria Transport Policy Institute http://www.vtpi.org/ Smart Growth Canada Network http://www.smartgrowth.ca/home_e.html Sightline Institute http://www.sightline.org/research/sust_toolkit/ solutions/healthy-comm. Canada Mortgage and Housing Corporation (CMHC) Comparing Neighbourhoods for Sustainable Features. www.cmhc-schl.gc.ca/en/co/buho/sune/ index.cfm Focus Edmonton City Plan www.focusedmonton.ca/home.html Walkable Edmonton www.edmonton.ca/walkableedmonton How healthy are we? / 2007 we? are healthy How

57

Copyright Notice

This document is the property of (AHS). On April 1, 2009, AHS brought together 12 formerly separate health entities in the province: nine geographically based health authorities (Chinook Health, Palliser Health Region, Calgary Health Region, David Thompson Health Region, East Central Health, Capital Health, Aspen Regional Health, Peace Country Health and Northern Lights Health Region) and three provincial entities working specifically in the areas of mental health

(Alberta Mental Health Board), addiction (Alberta Alcohol and Drug Abuse Commission) and cancer (Alberta Cancer Board).