Population Health Profile: Toronto Central LHIN Health System Intelligence Project (HSIP) HSIP-PHP-01 Produced by HSIP for the Local Health Integration Networks (LHINs). HSIP is an independent, credible source of information and an initiative of the Health Results Team for Information Management (HRT-IM). The Population: The Toronto Central LHIN is home to Executive Summary: This report provides an 1,146,800 people; 9.3% of the population of Ontario. During overview of the Toronto Central LHIN using the 1994-2004 time period the population of Toronto Central grew, on average, by 0.9% each year. The the most recently available data on social and population of Ontario increased by 1.5% annually during demographic characteristics, health status, this same time. Table 1 provides an overview of the social health practices and outcomes of the and demographic characteristics of the Toronto Central population. Rates or proportions for Ontario population. Compared to the province, Toronto Central has a higher proportion of immigrants and visible minorities. are provided as a comparator. Two percent of the population is Francophone (i.e., claim Relative to the province, Toronto Central has French as their mother tongue). The unemployment rate in Toronto Central is slightly higher than the provincial rate, a higher but the proportion of the Toronto Central population living • proportion of immigrants and visible in low income is substantially greater than the provincial minorities average. Fifty-six percent of adults (age 20+) have attained • level of educational attainment post-secondary education credentials, and almost 23% have not completed high school. and a lower Chart 1 shows the population structure of Toronto Central. • prevalence of arthritis/rheumatism and The black line provides the Ontario population distribution for comparison. The population pyramid chronic bronchitis shows a noticeable bulge in the 25-39 age groups. • prevalence of overweight/obesity Compared to the province, a much greater proportion of • age-standardized hospitalization rates the Toronto Central population are young adults. However, the Toronto Central area has a much smaller proportion of The Toronto Central LHIN has a children and youth compared to Ontario. heterogeneous population with the highest Chart 1: Age-sex population distribution rates of low income and single parent families, 90+ 85-89 but also the highest rates of completed 80-84 Male Female 75-79 post-secondary education. In general, the 70-74 65-69 Ontario health status and practices of the population 60-64 55-59 are similar to the province as a whole. Age Group 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 5 4 3 2 1 0 1 2 3 4 5 Percentage of Total Population Data Source: 2004 Population estimates, Statistics Canada Table 1: Socio-demographic characteristics TORONTO CENTRAL ONTARIO LHIN Range Total population (2004)† 1,146,800 12,392,700 242,500 - 1,542,900 Senior population, age 65+ (2004)† 13.3% 12.8% 9.4 - 15.7% Population with English mother tongue 58.5% 71.9% 55.7 - 92.2% Population with French mother tongue 2.0% 4.7% 1.2 - 25.1% Population who are immigrants 42.8% 26.8% 6.4 - 45.7% Population who are recent immigrants (arrived between 1996-2001) 9.3% 4.8% 0.3 - 9.7% Population who are visible minorities 31.6% 19.1% 1.3 - 38.8% Population of Aboriginal identity 0.6% 1.7% 0.3 - 13.9% Labour force participation rate (age 15+) 68.3% 67.3% 60.0 - 72.0% Unemployment rate (age 15+) 6.6% 6.1% 5.0 - 9.8% Population in low income 22.3% 14.4% 10.0 - 22.3% Families (with children) headed by a lone parent 30.0% 23.4% 19.4 - 30.0% Population (age 20+) with less than grade 9 education 10.5% 8.7% 6.3 - 12.0% Population (age 20+) without high school graduation certificate 22.7% 25.7% 19.2 - 33.4% Population (age 20+) with completed post-secondary education 55.8% 48.7% 42.4 - 55.8% Data Source: †2004 Population estimates. Remaining indicators based on 2001 Census of Canada. Health Status: Life expectancy at health, an indicator of overall health Health Practices and Preventive birth is the average years of life an status, can reflect aspects of health Care: Poor health practices are known individual could live on the not captured in other measures, such to be related to increased risk of assumption that current, cross- as disease severity, aspects of positive chronic disease, mortality and sectional age-specific mortality rates health status, physiological and disability. Chart 2 shows that the remain constant over the life span. psychological reserves and social and prevalence of daily smoking, heavy Infant mortality is a long-established mental function. Fifty-eight percent of drinking, exposure to ETS, measure, not only of child health, but the Toronto Central population rated consumption of fruits & vegetables, also of the well-being of a society. their overall health as “Excellent” or and physical inactivity in Toronto Data quality issues with mortality data “Very Good”, similar to the Ontario Central is similar to that in Ontario. preclude the calculation of life average of 57.4%. Almost 22% of Based on Body Mass Index 29.7% of expectancies and infant mortality Toronto Central residents report being the adult population of Toronto rates for Toronto Central at this time. limited in their activities because of Central is considered overweight and Low birthweight is an important a physical or mental condition or 8.5% are obese. The combined determinant of infant morbidity and health problem which has lasted or prevalence of overweight/obesity in mortality. In Toronto Central 5.6% of is expected to last longer than six Toronto Central is significantly lower infants born in 1999-2001 were of low months. than Ontario. The proportion of adults birthweight (Table 2). Self-reported in Toronto Central reporting that they have a lot of life stress (25.5%) is similar Table 2: Health status to the provincial average (24.4%). TORONTO CENTRAL ONTARIO LHIN Range The use of preventive health care Female life expectancy at birth (years), 2001† • 82.1 (±0.1) 79.5 - 82.2 services can lead to early detection of Male life expectancy at birth (years), 2001† • 77.5 (±0.1) 74.7 - 80.6 disease, which ultimately results in Low birth weight babies (1999-2001)‡ 5.6% 5.6% 3.7 - 6.2% reduced morbidity and mortality. Infant mortality rate per 1000 livebirths (1999-2001)†‡ • 5.4 (±0.2) 3.9 - 6.1 Mammography, Pap smear and flu shot Population who say their health is Excellent or 58.3% (±3.4) 57.4% (±0.7) 51.0 - 61.5% rates for Toronto Central are similar to Very Good, 2003 (age 12+) # provincial rates (see Table 3). Population with an activity limitation, 2003 (age 12+) # 21.6% (±2.6) 24.6% (±0.6) 19.3 - 30.0% The point of access for most medical • Not calculated due to data quality issues. care is through a primary care physician. Data sources: † Ontario Vital Statistics, Mortality Database, ‡ Ontario Vital Statistics, Livebirths Database # Canadian Community Health Survey, 2003 Medical doctors also play a key role in coordinating care and managing chronic Table 3: Use of preventive care conditions. The majority of the TORONTO CENTRAL ONTARIO LHIN Range population (83.7%) in Toronto Central Had mammogram in past 2 years (females age 50-69) 74.1% (±7.6) 70.6% (±1.9) 65.8 - 77.2% had at least one contact, either in person Had Pap smear test in past 3 years (females age 18+) 72.9% (±4.2) 69.2% (±1.0) 65.4 - 75.5% or by phone, with a medical doctor in Had flu shot in past year (age 12+) 31.4% (±3.4) 34.2% (±0.7) 30.3 - 39.0% the past year. This is similar to the Contact with Medical Doctor in past year (age 12+) 83.7% (±2.5) 81.4% (±0.6) 76.4 - 83.7% Ontario rate of 81.4%. Data source: Canadian Community Health Survey, 2003 Chart 2: Health practices, population age 12+ Chart 3: Prevalence of selected chronic conditions, population age 12+ Daily smokers 16.3% 13.9% * Arthritis/rheumatism 16.8% Toronto Central 17.5% Non-smokers exposed Ontario 8.1% to ETS at home† 14.1% 9.1% High blood pressure 14.7% Heavy drinkers‡ 20.6% 21.2% 7.4% Asthma 8.3% Physically inactive 48.5% 47.1% 4.1% ** Diabetes Obese or overweight 38.1% 4.6% * Toronto Central (age 18+) 48.5% Ontario * 1.4% * * Consume fruits & 40.3% Chronic bronchitis 2.7% veg 5+ times/day 40.2% 5.5% ** Have a lot of 25.5% Heart disease (age 30+) life stress (age 18+) 24.4% 7.2% 0% 10% 20% 30% 40% 50% 60% 0% 5% 10% 15% 20% † ETS - environmental tobacco smoke (second-hand smoke) * Significantly different from provincial average based on assessment of 95% confidence interval. ‡ as a proportion of current drinkers **Estimates for Chronic bronchitis, diabetes and heart disease have a high degree of sampling * Significantly different from provincial average based on assessment of 95% confidence interval. variability and must be interpreted with caution. Data Source: Canadian Community Health Survey, 2003 Data Source: Canadian Community Health Survey, 2003 Morbidity and Mortality: Chronic conditions place a high is significantly lower than the provincial rate. Note that burden on the health care system and reduce the quality of the prevalence estimates for diabetes, heart disease and life of those who suffer from the condition. Chart 3 shows chronic bronchitis must be interpreted with caution the prevalence of chronic conditions in Toronto Central and because of high sampling variability. Prevalence rates Ontario. Compared to the province, Toronto Central has a presented in Chart 3 are not age-standardized, and similar prevalence of chronic conditions such as high blood therefore areas with a high proportion of seniors will pressure, asthma, diabetes and heart disease. The prevalence tend to have higher rates of chronic conditions. of arthritis/rheumatism and chronic bronchitis however, Table 4: Mortality, PYLL and hospitalization rates by ICD-10 chapter Age-standardized mortality rate Potential Years of Life Lost rate Age-standardized hospitalization per 100,000 (avg. 2000-01)† per 100,000 (avg. 2000-01)† rate per 100,000 (2003-04)‡ Cause (ICD-10 chapter) TORONTO CENTRAL ONTARIO TORONTO CENTRAL ONTARIO TORONTO CENTRAL ONTARIO ALL CAUSES q 602.6 q 4,864 6,273.6 7,746.7 I. Infectious diseases q 9.3 q 122.3 116.8 119.9 II. Neoplasms q 181.4 q 1,590.3 527.5 549.6 III. Diseases of blood q 2.1 q 18.4 61.8 76.2 IV. Endocrine/nutritional disorders q 26.1 q 171.0 144.0 173.7 V. Mental & behavioural disorders q 15.0 q 59.2 500.3 502.7 VI. Nervous system diseases q 24.8 q 142.9 86.9 111.6 VII. Eye diseases q - q - 22.4 20.1 VIII. Ear diseases q - q 1.1 12.6 20.7 IX. Circulatory system diseases q 209.1 q 852.9 748.2 1,007.5 X. Respiratory system diseases q 45.4 q 150.5 473.0 624.6 XI. Digestive system diseases q 22.6 q 191.1 630.5 761.2 XII. Skin diseases q 1.0 q 3.9 55.0 65.9 XIII. Musculoskeletal diseases q 3.8 q 24.8 254.3 356.0 XIV. Genitourinary diseases q 11.1 q 38.2 290.1 421.0 XV. Maternal conditions q 0.1 q 4.6 1,255.1 1,367.8 XVI. Perinatal conditions q 4.2 q 266.5 67.9 71.7 XVII. Congenital abnormalities q 3.1 q 158.0 41.9 47.9 XVIII. Symptoms not elsewhere classified q 10.8 q 234.0 263.5 457.9 XIX. Injury & poisoning q n/a q n/a 460.4 578.6 XX. External causes of mortality q 32.6 q 834.3 n/a n/a XXI. Factors influencing use of services q n/a q n/a 255.2 408.6 q Not calculated due to data quality issues - Data suppressed due to small numbers Data sources: † Ontario Vital Statistics, Mortality Database ‡ Ontario Hospital Inpatient Database Table 4 provides age-standardized hospitalization rates Map 1: Population distribution in Toronto Central for Toronto Central and Ontario. Data quality issues with mortality data preclude the provision of mortality and PYLL rates at this time. PYLL rates are useful for quantifying the number of years of life “lost” from deaths that occur “prematurely” (i.e., before age 75). Although PYLL rates for Toronto Central are not provided, Table 4 shows that, provincially, neoplasms contribute to more years of potential life lost than any other cause, followed by circulatory system diseases, and external causes (i.e., injuries). All-cause hospitalization rates in Toronto Central are lower than provincial rates as are the cause-specific hospitalization rates for every ICD-10 chapter with the exception of chapter seven (e.g., diseases of the eye). Map 1 shows the 2001 population distribution (mapped by dissemination areas) within the Toronto Central LHIN area. The Toronto Central LHIN includes 44% of the population of the City of Toronto. Authors: Namrata Bains, Kristin Dall, Carley Hay, Michael Pacey, Jennifer Sarkella and Mary Ward Glossary Dissemination areas (DAs): the smallest standard geographic area for which census data are disseminated. DAs are composed of one or Age-standardization: adjustment for variations in population age more neighbouring blocks, with a population of 400 to 700 persons. distributions over time and place. Mortality and hospitalization rates are Hospitalization rate: refers to the hospital separation rate for all adjusted using the Direct Method and the 1991 Canadian population. hospital inpatients excluding newborns and stillbirths. A separation Body Mass Index (BMI): a measure of body weight adjusted for may be due to death, discharge home, or transfer to another facility. height which is correlated with body fat. BMI is defined as weight in ICD-10: refers to the International Classification of Diseases, 10 th kilograms divided by height in meters squared. A BMI of 30 or more revision. The ICD is used to classify diseases and other health is classified as obese. problems recorded on many types of health and vital records including Census subdivision: area that is a municipality or an area that is death certificates and hospital records. ICD chapters are broad deemed to be equivalent to a municipality for statistical reporting classifications which are subdivided into more specific conditions. purposes (e.g., as an Indian reserve or an unorganized territory). Potential Years of Life Lost: represents the number of years not lived Municipal status is defined by laws in effect in each province and by an individual from birth to age 75 due to premature death. The territory in Canada. PYLL rate provides the total years of life lost before age 75 to the Confidence intervals: indicate the degree of variability associated total population under 75. with an estimate. A 95% confidence interval indicates that estimates Sampling variability: estimates derived from survey data, rather are accurate within the upper and lower confidence interval 19 times than full counts of a population, have a degree of uncertainty that out of 20. Upper and lower bounds are shown as ± values in tables increases as the size of group surveyed decreases. and error bars in charts. Statistical significance: an inference that a result is unlikely to have occurred due to chance alone.