Population Health Profile

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					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+
   but also the highest rates of completed                                                                    80-84               Male                     Female
   post-secondary education. In general, the                                                                  70-74
                                                                                                              65-69                                                     Ontario
   health status and practices of the population                                                              60-64
   are similar to the province as a whole.
                                                                                                  Age Group

                                                                                                                      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%                                                   *
                          16.8%                                           Toronto Central                                                 17.5%

Non-smokers exposed                                                       Ontario
    to ETS at home†                                                                                                                       14.1%
                          9.1%                                                                                     High blood pressure

       Heavy drinkers‡    20.6%
                          21.2%                                                                                                           7.4%
     Physically inactive 48.5%
                                                                                                                                          4.1%                     **
Obese or overweight 38.1%                                                                                                                 4.6%
                                                                     *                                                                                                                      Toronto Central
          (age 18+) 48.5%
                                                                                                                                                  *   1.4% * *
      Consume fruits & 40.3%                                                                                        Chronic bronchitis
       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.

                                                                             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.