What Do Regional Differences in Health Outcom. Outcomes Tell Us?
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1 What Do Regional Differences in Health Outcomes Tell Us? Wilfrid Laurier University October 24, 2012
2 Health Profile in Canada Health profiles give an overview of population health for local health units.
3 Health Profile in Canada Health profiles give an overview of population health for local health units. Health regions: administrative areas defined by the provincial ministries of health. Statistics Canada provides the health profiles:
4 Health Profile, Fredericton, June 2012 Home > Health in Canada > Health Profile > Search results for "Zone 3 - Fredericton area" > Health Profile, June 2012 table Download Map Hierarchy Related data Help Select a view All data Rates Counts Submit Zone 3 - Fredericton area 1303-C New Brunswick (Health region) Select another region New Brunswick (Province) Select another region Figures Zone 3 - Fredericton area (HR) New Brunswick Well-being Total Male Female Total Male Female Perceived health, very good or excellent (%) Perceived mental health, very good or excellent (%) Perceived life stress (%) Figures Zone 3 - Fredericton area (HR) New Brunswick Health Conditions Total Male Female Total Male Female Overweight or obese (%)
5 Health profiles can be useful since they provide some references: They allow us to compare with the national average, provincial averages, and comparison over time within the same local health unit.
6 Some characteristics are correlated with population health: Income, Education, Population Composition etc.
7 Objective of this project: To provide ranking of health regions conditional on some regional characteristics
8 Source CANSIM Canadian Community Health Surveys, 2007, 2008, 2009, 2010
9 Health Regions Used 2011 boundaries. Boundaries have changed over time, but fairly stable since 2007.
10 Fixed Effect Model y it = X it β + i HR i + ε it y it : health outcome measure X it : population characteristics rural residents (%) individuals with university degree (or above) (%) population over 65 years old (%) unemployment rate (%) year dummies
11 Random Effect Model y it = X it β + u i + ε it u i : time-invariant error term normally distributed
12 Health Outcome Measures 1. Perceived health, excellent or very good 2. Perceived mental health, excellent or very good 3. Life satisfaction, satisfied or very satisfied 4. Proportion of individuals who are obese, based on BMI
13 Summary Statistics Mean Std. Dev. 10th 90th 1. Perceived health (6.545) Perceived mental health (4.838) Life Satisfaction (9.256) BMI (obese) (4.466)
14 Fixed Effect General Mental Life BMI Health Health Satisfaction Rural residents (%) (3.132) (5.021) (2.950) (4.159) Univ. degree 10.12* (%) (4.745) (9.713) (5.416) (6.045) Pop. over (%) (0.036) (0.034) (0.062) (0.066) Unemp. rate (%) (0.200) (0.239) (0.123) (0.1685),, indicate 1%, 5%, 10% significance level, respectively.
15 Random Effect General Mental Life BMI Health Health Satisfaction Rural * residents (%) (1.985) (1.816) (0.868) (2.123) Univ. degree 15.94*** 7.989* *** (%) (4.911) (4.659) (2.248) (5.057) Pop. over * *** * *** (%) (0.007) (0.006) (0.003) (0.008) Unemp. rate ** (%) (0.097) (0.089) (0.043) (0.101),, indicate 1%, 5%, 10% significance level, respectively.
16 A1: Perceived Health, Excellent or Very Good Top Unconditional Fixed Effect Random Effect 1 Halton Huron Huron (3536) (3539) (3539) 2 Calgary South Eastern South Eastern (4832) (4625) (4625) 3 North Shore Oxford Oxford (5933) (3552) (3552) 4 Huron Central Central (3539) (4640) (1012) 5 Ottawa Labrador Central (3551) (1014) (4640)
17 A2: Perceived Health, Excellent or Very Good Top Unconditional Fixed Effect Random Effect 1 Halton (3536) 12th 9th 2 Calgary (4832) 62nd 22nd 3 North Shore (5933) 9th 12th 4 Huron (3539) 1st 1st 5 Ottawa (3551) 52nd 28th
18 B1: Perceived Health, Excellent or Very Good Bottom Unconditional Fixed Effect Random Effect 1 South Shore Toronto South Shore (1210) (3595) (1210) 2 Zone 6, Bathurst Montreal Sunrise (1306) (2406) (4705) 3 Sunrise South Shore Zone 6, Bathurst (4705) (1210) (1306) 4 NOR-MAN Zone 6, Bathurst Zone 1, Moncton (4670) (1306) (1301) 5 Porcupine Monteregie Porcupine (3556) (2416) (3556)
19 B2: Perceived Health, Excellent or Very Good Bottom Unconditional Fixed Effect Random Effect 1 South Shore (1210) 3rd 1st 2 Zone 6, Bathurst (1306) 4th 3rd 3 Sunrise (4705) 7th 2nd 4 NOR-MAN (4670) 60th 28th 5 Porcupine (3556) 9th 5th
20 C1: Perceived Mental Health, Excellent or Very Good Top Unconditional Fixed Effect Random Effect 1 Halton Capitale Halton (3536) (2403) (3536) 2 Capitale Halton Cote-Nord (2403) (3536) (2409) 3 Cote-Nord Toronto Capitale (2409) (3595) (2403) 4 Huron Monteregie Huron (3539) (2416) (3539) 5 Laurentides Montreal Region de Laval (2415) (2406) (2413)
21 C2: Perceived Mental Health, Excellent or Very Good Top Unconditional Fixed Effect Random Effect 1 Halton (3536) 2nd 1st 2 Capitale (2403) 1st 3rd 3 Cote-Nord (2409) 14th 2nd 4 Huron (3539) 20th 4th 5 Laurentides (2415) 9th 6th
22 D1: Perceived Mental Health, Excellent or Very Good Bottom Unconditional Fixed Effect Random Effect 1 Zone 1, Moncton NOR-MAN Zone 1, Moncton (1301) (4670) (1301) 2 Parkland South Shore NOR-MAN (4660) (1210) (4670) 3 Sunrise Zone 7, Miramichi South Shore (4705) (1307) (1210) 4 Northern Interior Northwest Northern Interior (5952) (5951) (5952) 5 Northwest Burntwood Parkland (5951) (4685) (4660)
23 D2: Perceived Mental Health, Excellent or Very Good Bottom Unconditional Fixed Effect Random Effect 1 Zone 1, Moncton (1301) 6th 1st 2 Parkland (4660) 8th 5th 3 Sunrise (4705) 9th 8th 4 Northern Interior (5952) 7th 4th 5 Northwest (5951) 4th 6th
24 E1: Life Satisfaction, Satisfied or Very Satisfied Top Unconditional Fixed Effect Random Effec 1 Cote-Nord Cote-Nord Cote-Nord (2409) (2409) (2409) 2 Chaudiere-Appalaches Gaspesie Chaudiere-Appal (2412) (2411) (2412) 3 Lanaudiere Zone 7, Miramichi Capitale (2414) (1307) (2403) 4 Gaspesie Huron Lanaudiere (2411) (3539) (2414) 5 Capitale Zone 6 Monteregie (2403) (1306) (2416)
25 E2: Life Satisfaction, Satisfied or Very Satisfied Top Unconditional Fixed Effect Random Effect 1 Cote-Nord (2409) 1st 1st 2 Chaudiere-Appalaches (2412) 44th 2nd 3 Lanaudiere (2414) 50th 4th 4 Gaspesie (2411) 2nd 17th 5 Capitale (2403) 96th 3rd
26 F1: Life Satisfaction, Satisfied or Very Satisfied Bottom Unconditional Fixed Effect Random Effect 1 Toronto Toronto NOR-MAN (3595) (3595) (4670) 2 NOR-MAN Montreal Haldimand-Norfork (4670) (2406) (3534) 3 Vancouver Monteregie Pictou County (5932) (2416) (1240) 4 Haldimand-Norfork Edmonton Vancouver (3534) (4834) (5932) 5 Windsor-Essex Calgary Thompson, Cariboo (3568) (4832) (5914)
27 F2: Life Satisfaction, Satisfied or Very Satisfied Bottom Unconditional Fixed Effect Random Effect 1 Toronto (3595) 1st 12th 2 NOR-MAN (4670) 26th 1st 3 Vancouver (5932) 8th 4th 4 Haldimand-Norfork (3534) 34th 2nd 5 Windsor-Essex (3568) 15th 6th
28 G1: BMI, Obese Top Unconditional Fixed Effect Random Effect 1 Vancouver Richmond Richmond (5932) (5931) (5931) 2 Richmond Vancouver Vancouver (5931) (5932) (5932) 3 North Shore North Shore North Shore (5933) (5933) (5933) 4 Fraser North Saguenay Saguenay (5922) (2402) (2402) 5 York North Vancouver Island North Vancouver Is (3570) (5943) (5943)
29 G2: BMI, Obese Top Unconditional Fixed Effect Random Effect 1 Vancouver (5932) 2nd 2nd 2 Richmond (5931) 1st 1st 3 North Shore (5933) 3rd 3rd 4 Fraser North (5922) 6th 9th 5 York (3570) 14th 16th
30 H1: BMI, Obese Bottom Unconditional Fixed Effect Random Effect 1 Burntwood Burntwood Burntwood (4685) (4685) (4685) 2 NOR-MAN South Shore North Zone (4670) (1210) (4835) 3 South Shore Toronto South Shore (1210) (3595) (1210) 4 Zone 5 (Campbellton) Central Zone 1 (Moncton) (1305) (1012) (1301) 5 Labrador North Zone Interlake (1014) (4835) (4630)
31 H2: BMI, Obese Bottom Unconditional Fixed Effect Random Effec 1 Burntwood (4685) 1st 1st 2 NOR-MAN (4670) 12th 7th 3 South Shore (1210) 2nd 3rd 4 Zone 5, Campbellton (1305) 11th 12th 5 Labrador (1014) 6th 6th
32 Health profiles are useful for policy makers as a guide and/or a reference. However, health profiles based on unconditional health outcomes can be misleading. We provide some health profiles controlling for some regional characteristics. We find some regions relative ranking are altered.
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