2006 Wellington-Dufferin-Guelph. Health Status Report. JoAnn Heale May W e l l i n g t o n - D u f f e r i n - G u e l p h

Transcription

1 2006 Wellington-Dufferin-Guelph Health Status Report JoAnn Heale May 2006 W e l l i n g t o n - D u f f e r i n - G u e l p h P u b l i c H e a l t h

2 Table of Contents Section 1 Who Are We? Page About Our Population Who Else Are We Like? Socioeconomic Profile of WDG Families in WDG Ethnic and Cultural Groups in WDG Visible Minority Population in WDG Knowledge of Official Languages in WDG Education, Employment, and Income 8 Section 2 How Healthy Are We Now? Page Chronic Disease in WDG Causes of Death in WDG Causes of Hospital Use in WDG Emergency Department Visits Cancer Incidence in WDG Reportable Diseases in WDG Reproductive Health in WDG Teenage Pregnancies and Births Low and High Birth Weight Babies Breastfeeding Neural Tube Defects Dental Health Children in Need of Dental Treatment in WDG 29 Section 3 How Healthy Will We Be in the Future? Page Risk Factors for Chronic Disease and Injury That You Can Change Tobacco Use Physical Activity, Overweight/Obesity, Unhealthy Eating and Sedentary Activity Preventive Practices Influenza Immunization Breast Screening (Mammography) Cervical Screening (Pap Smear) 36

3 2006 Wellington-Dufferin-Guelph Health Status Report Section 1: Who Are We? 1.1 About Our Population Population aging and population growth are two critical factors in population health needs, since health problems increase with age (especially for chronic disease) and the population size affects the magnitude of these problems. Between 1996 and 2001, the population of Wellington- Dufferin-Guelph (WDG) 1 increased by 10% (from 219,780 to 244,200). The 2006 population is estimated to be 265,700 and is projected to grow to 279,600 by This is more than double the provincial growth rate of 7%. Figure 1.1 below illustrates the relative, projected population growth in Wellington and Dufferin counties between 2001 and Although Dufferin County has a higher projected growth than either Guelph or the rest of Wellington County, this represents an increase of about 10,000 persons in Dufferin compared with an increase of 24,500 projected for Wellington (15,500 for Guelph and 9,000 for the rest of Wellington). Figure and 2011 Population and Growth Rate for Wellington and Dufferin Counties. Provincial growth rate = 7% Wellington County 193,900 Dufferin County 51,300 Dufferin 19.5% Growth (10,000 people) Guelph 14.0% Growth (15,500 people) Wellington % Growth (24,500 people) Wellington County 218,400 Dufferin County 61, The geographic boundaries of the area served by Wellington-Dufferin-Guelph Public Health are actually the counties of Wellington and Dufferin. The city of Guelph is located within Wellington County. 2 Statistics Canada, Demography Division, based on 1996 Census Canada adjusted for undercounting, Provincial Health Planning Database (PHPDB), July Note: projections based on 2001 Census are not yet available (August, 2004). The 2001 population based on the adjusted 2001 Census was larger than the projection based on the 1996 Census - 0.5% greater for WR; 1.8% for WC; 3.4% for DC. Wellington-Dufferin-Guelph Public Health 3 of 36

4 As the baby boomer cohort ages, the number of people aged 50 years and older has been increasing more rapidly than other age groups. This age group comprised 26% of the population (182,200) in 2001 but will grow to 32% of the population by 2011 (254,200). The population aged 65 years and older is expected to increase quickly as well from 11% (78,200) of the population in 2001 to 13% (99,200) in Conversely, there will be a decrease in the number of people in the younger age groups in WDG. This population shift is expected to continue into the future: Figure 2 below illustrates this with the projected populations for 2005 and 2015 by age group. Figure 1.2. Percent of population of WDG represented by each age group in 2005 and Who Else Are We Like? Recently, Statistics Canada 3 used a range of social and economic factors that influence health to place health regions into peer groups with similar groupings of these characteristics. In Ontario, these peer groups are defined by public health unit boundaries. Peer groupings allow us to compare between health units on how well the health system is working. Wellington-Dufferin- Guelph Public Health is one of the health units in Peer Group B. Regions in this peer group are characterized as: mainly urban centres with moderately high population density; low percentage of the population relying on government transfer income; and, rapid population growth from 1996 to Other public health units in close proximity to WDG are also in Peer Group B including Waterloo, Peel, Halton, and Simcoe Regional Municipalities. Other areas that are adjacent to WDG or that provide health services to area residents but are in different peer groups, include London and Hamilton (Peer Group A) and Toronto (Peer Group G). 3 Health Regions and Peer Groups (revised), Statistics Canada, June Wellington-Dufferin-Guelph Public Health 4 of 36

5 1.3 Socioeconomic Profile of WDG Population characteristics such as family structure, employment, income, education, and ethnicity are known to influence health status and health system use. Recent research, such as that reported earlier, has demonstrated that the difference in health status between groups is largely due to differences in the presence of major risk factors for chronic disease and injury. For example, smoking rates are more than twice as high in the low-income group compared with those in mid to high-income groups 4. People living alone (particularly the elderly) or those in lone-parent families are often more reliant on the formal health care system because of a lack of informal supports Families in WDG Several factors related to family composition can impact health and the use of the health system as mentioned above. Also important are time-related variables such as distance to work and time spent on unpaid care for seniors and children, since these reduce time available for maintaining or improving personal health and for accessing the health system. Important health-related information about families in WDG is summarized in Table 1.2. Information on Guelph is provided separately from the rest of Wellington County as this urban centre has different characteristics than the surrounding area. Table 1.2 shows that the proportion of female lone-parent families and the number of babies born to teen-aged mothers are lower in Wellington-Dufferin-Guelph than in the province as a whole. However, this area has a high proportion of residents who work in another Census Division (CD). Because of this, a smaller proportion of residents live within an active commuting-distance from work. As well, residents with a long daily commute have less time available for maintaining health and accessing health care. WDG also has a high proportion of residents who recently moved into the area from other parts of the province or Canada. These new residents are less likely to have a family doctor. They also may not know how to access health care in the region and are less likely to have a social support network Canadian Community Health Survey, electronic share file, Ontario Ministry of Health and Long-Term Care, Ad hoc data analysis by Wellington-Dufferin Guelph Health Unit, Wellington-Dufferin-Guelph Public Health 5 of 36

6 Table 1.2. Selected Family Life Characteristics of Canada, Ontario, and Wellington-Dufferin-Guelph Census Variables Canada Ontario Marital Status Wellington County Rest of City of Wellington Guelph Dufferin County Separated, divorced, widowed (15+ pop.) 17.0% 16.2% 15.3% 14.0% 16.2% 16.0% Female lone-parent families 12.7% 12.6% 9.8% 14.4% 7.2% 8.9% Birthrate to teenaged mothers (#/1000 females 15-19) Not available Average number of children at home per census family Not available 1.3 Number persons aged 65+ years living alone 1,040, ,550 5, ,145 Unpaid Caregivers (population aged 15+ years) Total population 15+ yrs 23,901,360 9,048, ,100 69,180 84,120 38,165 Providing 60+ hrs/wk unpaid child care (15+ pop.) 6.4% 6.3% 6.8% 7.5% 6.4% 9.1% Providing 10+ hrs/wk unpaid care or assistances to seniors (aged 65+ yrs) 2.7% 2.7% 2.0% 1.9% 2.1% 1.8% Distance to Work (population aged 15+ years) Males working in different Census Division 17.3% 22.0% 25.6% 28.7% 23.0% 46.3% Females working in different Census Division 14.1% 17.2% 18.8% 14.5% 24.9% 32.0% Source: 2001 Census Canada, 20% Sample, Statistics Canada, Ethnic and Cultural Groups in WDG Wellington and Dufferin counties are similar in ethnic origin. Over ninety percent of the population identifies itself as having English, Irish, Scottish, German, Dutch or Italian heritage (listed in descending order of population size). Recent immigrants, as well as those moving into or within Wellington-Dufferin from other parts of Canada (internal migrants) may have difficulty accessing the primary care system given the area s current status as under-serviced for family physicians. Recent immigrants may also face language and cultural barriers in accessing health care. Table 1.3 below provides a detailed breakdown for the total immigrant population in WDG and their place of origin (which does not necessarily reflect ethnicity), as well as for those who immigrated to the region between 1996 and Wellington-Dufferin-Guelph Public Health 6 of 36

7 Table 1.3. Place of Origin (Top Ten) of Immigrants All Years and Most Recent ( ) Wellington and Dufferin Counties, and Comparison with Ontario Census Variable Wellington C Ontario Census Variable Dufferin C Ontario # immigrants all years # immigrants all years 6130 % Immigrants all years 16.5% 26.8% % immigrants all years 12.2% 26.8% Where immigrants come from: Rank Rank Place of Origin: Rank Rank All other places of birth 2860 All other places of birth 555 United Kingdom United Kingdom Italy Germany India Netherlands China, People s Rep United States Philippines Jamaica Poland Italy Jamaica Poland United States Hungary Germany Ireland, Rep Vietnam India Census Variable Wellington C Ontario Census Variable Dufferin C Ontario # of Recent ( ) Immigrants 3655 # of Recent ( ) Immigrants 490 Recent Immigrants - % of total pop. 2.0% 4.8% Recent Immigrants - % of total pop. 1.0% 4.8% Place of origin: Rank Rank Place of origin: All other places of birth 620 All other places of birth 120 China, People s Rep United Kingdom India United States Afghanistan Japan Philippines Korea, South Yugoslavia Russian Federation United States Mexico Vietnam Germany United Kingdom China, People s Rep Russian Federation Philippines Romania India Source: 2001 Census Canada, 20% Sample, Statistics Canada, Visible Minority Population in WDG The visible minority population of a community may also predict health status. For example, the incidence of end-stage renal disease (ESRD) is much higher in the South and Southeast Asian, Black and Aboriginal populations in Canada, while hypertension and diabetes are more common in Black and Aboriginal people than in Caucasians. Table 1.4 below provides a breakdown of the visible minority population by municipality within Wellington-Dufferin. As seen throughout Ontario, the visible minority population in WDG is largely concentrated in the urban area, i.e., in Guelph. Wellington-Dufferin-Guelph Public Health 7 of 36

8 Table Visible Minority and Aboriginal Populations in Wellington and Dufferin Counties, Guelph, and Ontario % Asian at Area % Black risk for ESRD* % Aboriginal** % Total Visible Minority*** Wellington County Guelph Rest of Wellington Dufferin County Ontario Source: 2001 Census Canada, 20% Sample, Statistics Canada, 2003 *Asians at risk for End Stage Renal Disease (ESRD): South Asian, Chinese, Korean, Japanese, Southeast Asian, Filipino. ** From Census Canada questions: those identifying with at least one Aboriginal group; and/or reported to be a Treaty Indian or Registered Indian; and/or reported to be a member of an Indian Band or First Nation. *** Persons other than Aboriginal peoples who are non-caucasian in race, or non-white in colour Knowledge of Official Languages in WDG Knowledge of the official languages is important in accessing health services in Canada. In Wellington-Dufferin-Guelph, English or French is the language used in more than 93% of homes; while almost 99% of residents have knowledge of the official languages. These proportions are highest in Dufferin County and lowest in Guelph. Language Question Canada Ontario Knowledge of Official Languages Wellington County City of Guelph Rest of Wellington Dufferin County Neither English nor French (#) 446, ,780 1,725 1, Neither English nor French (%) Language of the Home Non-official language (#) 1,693, ,770 7,010 5,115 1, Non-official language (%) Source: 2001 Census Canada, 20% Sample, Statistics Canada, Education, Employment, and Income Being unemployed, having a low-paying job, and having a lower education can all affect your health. They can also affect your ability to access health services. Table 1.6 below shows that in 2001, WDG residents were better off than those in Ontario as a whole, or Canada. Average incomes were higher, unemployment was lower, and fewer families were categorized as low income. Wellington-Dufferin-Guelph Public Health 8 of 36

9 However, WDG also has a high number of people moving into the region from other parts of the province or country (internal migration) and these people may not know where to access health services. They are also less likely to have a family doctor or to have a social support network. Table 1.6. Selected Education, Income, and Labour Force Characteristics for Canada, Ontario, Wellington and Dufferin Counties, and Guelph Census Variable Canada Rest of Ontario Wellington Wellington Guelph Dufferin Education Total population years 6,898, ,195 46,410 64,785 30,025 % yrs without h.s. Not 16.6 graduation available % with university degree Income % of income from gov t transfer Not avail Median family income $ $55,016 $61,024 $65,746 Not avail. $65,525 $68,574 % low income in Not available 5.6 Employment Total labour force 15+ yrs 15,872,070 6,086, ,095 60,585 41, % unemployed - 25 years and over % unemployed years % employed in agricult/forestry/fishing % employed in health/social Mobility % internal migrants past yr % internal migrants past 5 yrs Source: 2001 Census Canada, 20% Sample, Statistics Canada, Wellington-Dufferin-Guelph Public Health 9 of 36

10 Section 2: How Healthy Are We Now? In projecting health needs, and in planning for future programs and services, it is important to examine the current health status of residents of Wellington-Dufferin-Guelph (WDG). This section describes population health status in several areas: chronic diseases, deaths, hospitalizations, emergency department visits, incidence of reportable diseases, reproductive health, and dental health Chronic Disease in WDG The table below provides data on the proportion of residents of Wellington-Dufferin-Guelph and Ontario-aged 12 years and older-that reported a chronic disease as diagnosed by a health professional in These conditions may not always result in use of the health care system by the individual but they may result in reductions in function and quality of life. Seventy percent of Ontarians had a least one chronic condition in 2003, compared with 68% of residents of WDG. The lower percentage for WDG is likely because there are fewer people in the 65 year and older population in the area compared with the province. Table 2.1. Self-Reported Prevalence* of Chronic Diseases and Conditions in Wellington- Dufferin-Guelph and Ontario , Population Aged 12+ Years Health Region Ontario Wellington-Dufferin- Guelph # % # % Any Chronic Condition 7,151,400 70% 143,000 68% Allergies (non-food) 3,024,700 29% 60,900 29% Back Problems (excluding fibromyalgia, arthritis) 2,077,500 20% 44,800 21% Arthritis/Rheumatism 1,798,500 18% 30,800 15% Osteoarthritis 867,000 8% 15,200 7% High Blood Pressure 1,515,600 15% 23,400 11% Migraines 1,127,300 11% 23,600 11% Mood or Anxiety Disorder 1,004,300 10% 15,800 8% Food Allergies 774,000 8% 16,800 8% Asthma had symptoms past year 466,600 5% 11,200 5% Heart Disease 520,500 5% 9,700 5% Diabetes 475,400 4% 8,700 4% Stomach Ulcers 291,100 3% 6,600 3% Urinary Incontinence 229,800 2% 5,000 2% Cancer 187,000 2% NR NR Source: 2001 Canadian Community Health Survey, Ontario electronic share file, weighted data, MOHLTC, NR - not reportable, < 30 respondents. Wellington-Dufferin-Guelph Public Health 10 of 36

11 Because the Canadian Community Health Survey (CCHS) survey is now repeated biannually, these data also provide an opportunity to examine emerging trends in chronic disease. For example, data over time from the CCHS indicate that the number of people living with diabetes in Canada has doubled since 1996/97. The most prevalent of the chronic conditions (i.e., non-food allergies, asthma, arthritis, back problems, high blood pressure, and migraines) are conditions that are ideally managed through primary prevention by way of lifestyle choices or within the primary care system. However, in areas that are under-serviced for family physicians, such as WDG, these conditions may become acute and result in emergency department visits and hospital admissions-at a much greater cost to the health system. In addition, those with chronic conditions tend to be at greater risk for infectious and communicable diseases (such as influenza) as well Causes of Death in WDG As in all developed nations worldwide, the leading causes of death 5 in WDG are noncommunicable diseases and injury. The top five from were: first - cardiovascular diseases (average of 610 deaths per year), second - cancers (475 per year), third - respiratory diseases (138), fourth - diseases of the endocrine and metabolic system (66), and fifth - injuries and poisonings, including suicide (85). These leading causes are all significantly related to lifestyle factors and the prevalence of these factors in WDG is discussed further in Section 3. Since death is inevitable, and therefore there is no possibility of preventing all deaths, it is important to pay attention to the causes of death for people younger than 65 years, as these can be considered premature deaths and may be preventable. The leading causes of death for the population younger than 65 years are provided in Figures 2.1. For the younger age group in WDG, the five leading causes of death between 2000 and 2002 are the same as for seniors (65 years and older), but the relative ranking of each is different. For the group younger than 65, cancer ranked first (average of 125 deaths per year), followed by heart disease (71), injuries and poisonings (50), respiratory diseases (17) and then endocrine/metabolic diseases and nervous disorders (11 each). For males, there are more deaths in those younger than 65 years (194 for males vs. 135 for females) mainly because there are significantly more deaths due to injuries, including suicide (35 vs. 15) and cardiovascular disease (49 vs. 21). It is also important to look at subcategories within the major disease groupings, as there may be different factors that contribute to diseases within a disease chapter. For example, smoking is a risk factor for lung cancer but not for colon cancer. Table 2-2 gives the age-standardized rates for the leading causes of death by major disease groupings (ICD10 Chapters), and by subcategories (groupings of relevant ICD10 codes within chapters) in WDG compared with a neighbouring peer group (Halton) and Ontario. Age-standardized rates are used for this comparison since they control for differences that may result solely because of differences in the age structure of the 5 Leading causes are grouped by ICD10 Chapter. ICD10 = International Classification of Disease, Version 10. The ICD10 is the accepted international standard for classifying cause of death and hospitalization. It has been used in Canada for hospitalizations since 2002, and for deaths since Wellington-Dufferin-Guelph Public Health 11 of 36

12 population in different geographic areas. For example, if an area has more people over the age of 65, death rates could be expected to be higher than in an area with fewer seniors. Figure 2-1. Leading Causes of Death for Those Under 65 Years of Age Wellington- Dufferin-Guelph, Average Annual Number of Deaths from Avg # deaths/yr Females (total deaths = 135) Males (total deaths = 194) Cancer Heart & Stroke Injury (incl. suicide) Digestive Respiratory Nervous Source: Vital Statistics, Mortality Table, Provincial Health Planning Database, Table 2.2 indicates that there are significantly more deaths due to cardiovascular disease in WDG than in either Halton or Ontario. Deaths from stroke in women (50/100000) and heart attack in men (170/100000) are particularly high in WDG. This is consistent with the higher rates of the risk factors for these diseases (i.e., smoking, physical inactivity, and obesity) in the WDG adult population as discussed further in Section 3. Wellington-Dufferin-Guelph Public Health 12 of 36

13 Table 2.2 Age Standardized Death Rates for Selected Leading Causes in Wellington- Dufferin-Guelph, Halton, and Ontario, (Average Annual) Cause of Death Geographic Area Total #/ Females #/ Males #/ Cardiovascular Disease All CVD Deaths Ontario Total Halton WDG Ischaemic Heart Ontario Total Disease Deaths (e.g., Heart Halton Attack) WDG Cerebrovascular Ontario Total Disease Deaths Halton (Stroke) WDG Respiratory Disease All Respiratory Ontario Total Deaths Halton WDG Pneumonia/Flu Ontario Total Halton WDG Bronchitis, Ontario Total Emphysema, Halton Asthma Deaths WDG Cancer All Cancer Incidence All Cancer Deaths Colorectal Cancer Deaths Female Breast Cancer Deaths Lung Cancer Deaths Prostate Cancer Deaths Ontario Total Halton WDG Ontario Total Halton WDG Ontario Total Halton WDG Ontario Total 25.3 Halton 29.2 WDG 28.6 Ontario Total Halton WDG Ontario Total 25.4 Halton 27.5 WDG 27.6 Source: 2005 Health Indicators Report, Canadian Institute for Health Information, Wellington-Dufferin-Guelph Public Health 13 of 36

14 Compared to Halton and Ontario, WDG had higher rates of death from respiratory disease (particularly pneumonia and influenza) and lung cancer. These diseases are all related to tobacco use and WDG has higher smoking rates (especially among females) than Halton or Ontario. The leading cause of cancer death for males and females in WDG between 2000 and 2002 was lung cancer, followed by breast cancer for women and prostate cancer for men. Colorectal cancer was the third leading cause of death for both. Age-standardized rates for injury causes were not provided in the data mentioned above. However, for WDG between 2000 and 2002, the leading causes of injury death were motor vehicle crashes (70), suicide (42) and falls (33). The leading injury causes differed for those under 65 years versus those 65 years and older (see Figure 2.6). For the younger age group, the leading injury causes of death were motor vehicle crashes (60 deaths from ) and suicide (37). There were only 5 deaths from falls in this age group. For seniors, there were 28 deaths from falls, 10 resulting from motor vehicle crashes, and 5 suicides. There were 50% more injury deaths in younger (150) vs. older (106) WDG residents, and in males (157) vs. females (99). Figure 2.3. Leading Causes of Injury Death in Wellington-Dufferin-Guelph by Age Group, Total Number of Deaths Yrs < 65 Yrs Females Males Females Males Females Males MV Crash MV Crash Suicide Suicide Falls Falls Source: Vital Statistics, Mortality Tables, Provincial Health Planning Database, Wellington-Dufferin-Guelph Public Health 14 of 36

15 2.3. Causes of Hospital Use in WDG There were 27,707 hospitalizations of WDG residents in 2004 or about 90 a day. As illustrated in Figure 2.3.1, the most hospitalizations were reported for the youngest age group. But the rates of hospitalization steeply increased from the year age group to a high of 4300/10000 in the year age group. Figure Hospitalizations of Wellington-Dufferin-Guelph Residents, by Age of Patient, , ,000 3,500 # Hospitalizations # Hosp/ # Hospital Discharges 3,000 2,500 2,000 1,500 1, # Dschgs/10000 Pop Source: Canadian Institute for Health Information, In-Patient Tables, Provincial Health Planning Database, March The leading causes of hospitalization (ICD10 Chapter of most responsible diagnosis) in WDG were factors influencing health status (3,080), cardiovascular diseases (2,970), pregnancy and childbirth (2,860), digestive problems (2,430), injuries and poisonings (1,890) and respiratory problems (1,860). As with causes of death, the leading causes of hospitalization for WDG residents differed for the under 65 year, versus the 65+ age groups, and between males and females (see Figures and 2.4.3). For females under the age of 65 years, there were almost twice as many hospitalizations for pregnancy and childbirth as for the next leading cause, factors influencing health status (1600). The third, fourth and fifth leading causes of hospitalizations for women were digestive (738) and genitourinary (673) problems, and mental and behavioural disorders (628). For males, the leading causes were factors influencing health status (1135), digestive (793) and circulatory (684) problems, injuries and poisonings (680), and mental and behavioural disorders (581). Wellington-Dufferin-Guelph Public Health 15 of 36

16 Figure Leading Causes of Hospitalization for Wellington-Dufferin-Residents Younger than 65 Years of Age, by Gender, ,500 3,000 # Discharges 2,500 Males 1,135 Females 2,000 1,500 2, , , Pregnancy & Childbirth Factors Influencing Health Status Digestive System Mental/Behavioural Disorders Injury & Poisoning Perinatal Conditions Circulatory System Respiratory System Genitourinary Cancer Source: Canadian Institute for Health Information, In-Patient Tables, Provincial Health Planning Database, March For the population over the age of 65 years, the leading causes of hospitalization mirror the leading causes of death. There were twice as many hospital stays for cardiovascular problems as for the next leading cause for both men and women. The second leading cause for men was respiratory disease (484), which was fourth for women (433). The second leading cause for women was injuries and poisonings (484), the majority of which were falls. Digestive problems were the third leading cause of hospitalization for both men (423) and women (480) in this age group. Wellington-Dufferin-Guelph Public Health 16 of 36

17 Figure Leading Causes of Hospitalization for Wellington-Dufferin-Residents 65 Years of Age and Older, by Gender, # Discharges , Circulatory System Respiratory System Digestive System Cancer Injury & Poisoning Signs, Symptoms Males Females Musculoskeletal Genitourinary Factors Influencing Health Status Mental/Behavioural Disorders Source: Canadian Institute for Health Information, In-Patient Tables, Provincial Health Planning Database, March Wellington-Dufferin-Guelph Public Health 17 of 36

18 2.4. Emergency Department Visits There were 111,301 visits to emergency departments by Wellington-Dufferin-Guelph residents in Unlike deaths and hospitalizations, the <1-4, and year age groups had the highest number and rate of emergency visits (see Figure 2.4.1). In every age group up to age 65, there were similar numbers of emergency visits by males and females in WDG, whereas in the 65 and over age group, there were more visits by females. Figure Emergency Visits by Wellington-Dufferin-Guelph Residents, by Age of Patient, by Gender, 2004 (Fiscal Year) 12,000 10,000 Males Females # Emergency Visits 8,000 6,000 4,000 2, Age Group (yrs) Source: National Ambulatory Care Reporting System, Ambulatory Care Tables, Provincial Health Planning Database, March The leading causes (ICD10 Chapter of main problem reported) of emergency visits for WDG residents in 2004 were injuries and poisonings (30,600 visits), followed by signs, symptoms and abnormal clinical findings 6 (20,800). These two groupings accounted for almost half of all emergency visits. The third, fourth, and fifth leading causes were respiratory problems (e.g., asthma, emphysema, pneumonia, influenza) with 12,400 visits, health factors influencing health status, and digestive problems were the third, fourth, and fifth leading causes. While males and females presented to emergency in equal numbers, males had 50% more visits for injuries and 6 Examples of codes descriptions for Chapter XVIII: Symptoms, signs and abnormal lab & clinical findings: acute pain, fever, abnormal findings in screening, diagnostics, abnormal blood levels, etc. Examples of code descriptions for Chapter XX1: Factors influencing health status & contacts with health services: examination, screening, diagnostic tests, observation, etc. Wellington-Dufferin-Guelph Public Health 18 of 36

19 poisonings (18,100 vs. 12,500), while females reported more than twice as many visits for genitourinary problems (2,800 vs. 1,100). Females were also more likely than males to present with ill-defined signs and symptoms (11,500 vs. 9,300), respiratory problems (6,600 vs. 5,800), or digestive problems (3,400 vs. 2,900). The leading causes for males and females are compared in Figure Figure Emergency Visits by Wellington-Dufferin-Guelph Residents, by Main Problem (ICD10 Chapter), by Gender ,000 # Emergency Visits 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 Females Males 0 Injury & Poisoning Symptoms, signs Respirator y System Factors Influenc. Health Digestive System Musculosk eletal System Genitourin ary Females 12,467 11,465 6,624 4,903 3,380 3,074 2,802 1,618 Males 18,128 9,333 5,794 5,393 2,956 2,815 1,091 1,735 Source: National Ambulatory Care Reporting System, Ambulatory Care Tables, Provincial Health Planning Database, March Circulatory System Of particular concern is the high number of emergency visits for injuries and poisonings by WDG residents, as these visits suggest missed opportunities for primary prevention. Figure further breaks down the injury and poisoning visits by type of injury for males versus females 7. The leading injury cause of emergency visits was a fall with about 8,000 visits; numbers were similar for males and females. There were almost 3,000 traffic-related emergency visits and just over 2,000 visits for sports injuries. Males were much more likely to present for sports-related injuries, assaults, and cyclist injuries, while females had higher numbers of visits for caroccupant injuries and intentional self-harm (attempted suicide). 7 The higher total number of injury and poisoning visits in Figure compared with results from the fact that External Cause tables in the Provincial Health Planning Database capture all causes reported at the emergency visit whether or not this was the main problem reported. Wellington-Dufferin-Guelph Public Health 19 of 36

20 Figure Emergency Visits for Injuries and Poisonings for Wellington-Dufferin-Guelph, by Type of Injury, by Gender, ,000 8,000 7,997 7,000 6,000 5,000 4,000 2,882 3,000 2,126 2,000 1,289 1,000 0 Fall (Unintentional) Total Traffic-related Injury Sports-related Injury Car Occupant Injury Cyclist injury Males (19,085 visits) Females (12,489 visits) Assault Other Trans Injury Intentional Self-harm Poisoning (Unintentional) injury-undeterm Intent (Y10-Y34) 2.5 Cancer Incidence in WDG Table provides the average annual number, and age standardized rates of cancer diagnoses by cancer site and by gender for WDG residents between 1998 and The agestandardized rate of cancer diagnoses was higher among men than among women in WDG (83.1 diagnoses per men vs. 71.2/ for women) in WDG between 1998 and This is largely because the risk of cancer increases with age and women live longer than men. There were actually more cancer diagnoses during that time among women (478 average annual) than for men (464 average annual). In men, the most commonly diagnosed cancer was prostate cancer (25/100000), followed by cancers of the lung (11/100000), colon (8/100000), and bladder (4/100000), and then lymphomas (3.7/100000). For women, the most commonly diagnosed cancer was breast cancer (21/100000), followed by cancers of the lung (7.5/100000), colon (7.2/100000), and uterus (4.4/100000), and then lymphomas (3.4/100000). Wellington-Dufferin-Guelph Public Health 20 of 36

21 Table Cancer incidence in Wellington-Dufferin-Guelph by Sex and by Cancer Site - Average Annual Total Population Males Females Avg Avg Avg Cancer Site Annual AS Avg Annual AS Avg Annual AS Avg Rate* Annual # Rate* Annual # Rate* Annual # All Sites Oral Cavity and Pharynx Digestive System Esophagus Stomach Colon excluding Rectum Rectum and Rectosigmoid Junction Pancreas Respiratory System Lung and Bronchus Soft Tissue including Heart Skin excluding Basal and Squamous Melanoma of the Skin Breast Female Genital System Cervix Uteri Not applicable Corpus and Uterus, NOS Ovary Male Genital System Prostate Not applicable Urinary System Urinary Bladder Brain and Other Nervous System Brain Endocrine System Thyroid Lymphoma Hodgkin Lymphoma Non-Hodgkin Lymphoma Myeloma Leukemia Lymphocytic Leukemia Myeloid and Monocytic Leukemia Other Leukemia Miscellaneous Source: Cancer Care Ontario, Ad Hoc Report, April *AS Rate age-adjusted rates to 1991 Canadian (18 age group) standard. Wellington-Dufferin-Guelph Public Health 21 of 36

22 2.6. Reportable Diseases in WDG The number and rates for the most common reportable disease cases per year are provided for WDG, Halton and Ontario in Table Table Average Annual Number and Rate of Select Reportable Diseases in Wellington- Dufferin-Guelph (WDG), Halton and Ontario, from WDG Halton Ontario 2005 Population: 260, ,200 13,240,300 # Selected Diseases cases #/ # cases #/ # cases #/ Foodborne/Waterborne/Enteric Diseases Campylobacter , Salmonellosis , Giardiasis , Sexually Transmitted Infections Chlamydial Infections , Gonorrhea , HIV/AIDS Communicable/Vaccine Preventable Diseases Influenza , Hepatitis C , Streptococcus Pneumoniae Source: Integrated Public Health Information System, Standard Report: Reportable Disease by Year, Cognos ReportNet, March The most commonly reported foodborne/waterborne/enteric diseases in 2005 were salmonella (100 cases) and campylobacter (94). The rates for both of these were 50% higher than the provincial rate. Higher rates may reflect more reporting and testing in an area, rather than higher rates of disease. There were much higher rates of influenza cases reported in WDG (63/100000) and Halton (61) than in the province as a whole (41). As with enteric diseases, this could reflect increased rates of seeking medical care and testing for influenza rather than increased rates of the disease. But it could also result from lower rates of seasonal influenza vaccination. Self-reported data from the 2003 Canadian Community Health Survey 4 indicated that the seasonal flu vaccination rate for the WDG population aged 12 years and older was 31% - lower than either the provincial (35%) or Halton rate (36%). The vaccination rate in the higher-risk, senior population was also lower in WDG (66%) compared with Ontario or Halton (both 70%). Rates for hepatitis C in WDG were 50% lower than provincial rates and about 33% lower than those in Halton. Rates for pneumonia in WDG (6/100000) were similar to rates in Halton (6) and the province (7). Wellington-Dufferin-Guelph Public Health 22 of 36

23 Chlamydial infection was the most frequently-reported sexually-transmitted infection. But the rate in WDG (119/100000) was 45% lower than the provincial rate (162) and higher than the rate in Halton (87). These infection rates are typically higher in areas with a university or college population, such as Guelph, and the highest rates were seen in the post-secondary age group. In particular, the year age group for females had a chlamydial infection rate of 988 per This was almost twice the provincial target of 500/ for this population. The WDG rate for gonorrhea (5/100000) was much lower than either Halton s (11) or Ontario s (25) and well below the 2005 provincial target of 15/ The number and rate of HIV/AIDS infection is not reportable (fewer than six cases) for either WDG or Halton; the provincial rate is 1/ population. 8 Mandatory Health Programs and Services Guidelines, Ontario Ministry of Health and Long Term Care, Wellington-Dufferin-Guelph Public Health 23 of 36

24 2.7. Reproductive Health in WDG There were 2,876 live births in WDG of which 7% were pre-term (less than 37 weeks gestation). Figure provides the number and rate of birth by age group of the mother in WDG in As in most parts of the western world, the average age of mothers has increased over the past three decades. In WDG the highest number and rate of births were to mothers in the year age group, followed by mothers in the year age group. There were more births to teenaged mothers (91) than to mothers over the age of 40 years (77) in Figure Live Births in Wellington-Dufferin-Guelph in 2003, by Age of Mother # Live Births Live Birth Rate # Live Births #/1000 Female Pop Age Group of Mother 0.0 Source: Vital Statistics, Live Births Table, Provincial Health Planning Database, May Because of projected population increases in the female year age group, it is estimated that the number of babies born per year in WDG will continue to increase. Based on the average annual increase in the number of live births over the past four years, it is projected that there will be 3,016 babies born in WDG in Wellington-Dufferin-Guelph Public Health 24 of 36

25 Teenage Pregnancies and Births 9 Teenaged mothers often interrupt or discontinue their education, have low income, and are more likely to be without a partner. All of these factors are associated with higher prevalence of health risk factors (e.g. smoking) and with poorer health outcomes for both mother and child. Pregnancy rates for teens are also an indicator of unsafe sexual practices, which also puts these teens (and their partners) at risk for sexually transmitted infections. Births and pregnancies in teenagers (younger than 20 years) in Wellington-Dufferin-Guelph are reported in Figure There were 93 live births and 149 pregnancies for teens in WDG in Births to teens were highest in the city of Guelph with 51 or a rate of 13 per 1000 females aged years 10. But all teen pregnancy rates in WDG were much lower than the target for teen pregnancies for the province which was 40 per These rates for WDG are consistent with rates that are typically seen in areas of higher socioeconomic status. Figure Teen Pregnancy and Live Birth Rates in Wellington-Dufferin-Guelph, Pregnancies 21.6 #/1000 females yrs Livebirths Wellington- Dufferin Dufferin County Wellington County City of Guelph Rest of Wellington Source: 2004 National Ambulatory Care Reporting System and 2004 Patient Abstract Database, Canadian Institute for Health Information, ad hoc query to Provincial Health Planning Database, January Teen pregnancy rates are calculated from the total number of live births, stillbirths, therapeutic abortions, and ectopic pregnancies in those younger than 20 years, divided by the female population aged years. Spontaneous abortions are not included, therefore pregnancy rates are an underestimate. 10 Live births to mothers younger than 15 years of age are included in the total, however the population used in the denominator of the rate is the female population aged years. Wellington-Dufferin-Guelph Public Health 25 of 36

26 2.7.2 Low and High Birth Weight Babies There is concern about the health consequences for babies that are born at a low weight (LBW - less than 2500 grams) or at a high weight (HBW grams or more). LBW in pre-term (< 37 weeks gestation) or multiple births occurs frequently and is not thought to be preventable, whereas the most common preventable cause of LBW in full-term singleton births is smoking during pregnancy. Whatever the cause of LBW, these babies often face health challenges. In 2002, there were 2,467 normal-weight full-term (FT) babies born in WDG. This represents 88% of the 2,805 live births. Figure below provides a breakdown of the pre-term (PT) and LBW or HBW babies born in singleton vs. multiple births in There were no HBW babies born in a multiple birth and only two who were pre-term. Figure Low, High and Normal Birth Weight in Pre-term (PT) and Full-term (FT) Babies in Wellington-Dufferin-Guelph in 2002 Singleton Live Births (Normal Weight, Full-Term = 2,420) Multiple Live Births (Normal Weight, Full-term = 47) Low - PT Low - FT Normal - PT High - FT High - PT (2) Low - PT Low - FT Normal - PT High - FT (0) High - PT (0) 89 7 Source: Vital Statistics, Live Births Table, Provincial Health Planning Database, Figure gives the incidence of high and low birth weight in live births in WDG from 1991 to In that time period, there were more high birth-weight (HBW) babies born: between 2.5% and 3.5% of live births were HBW compared with between 1% and 1.5% that were low birthweight (LBW). In 2002 in WDG, there were 36 full-term babies born weighing less than 2500 grams - LBW, while more than twice as many (88) weighed more than 4500 grams - HBW. There were 138 LBW babies born in WDG in 2002, or 5% of live births (includes both full-term and pre-term babies and singleton and multiple live births). The provincial target is 4% LBW by The incidence of HBW is a concern given the increasing prevalence of both childhood and adult overweight and obesity over the past two decades. However, there are no provincial targets for this indicator. Wellington-Dufferin-Guelph Public Health 26 of 36

27 Figure Incidence of Low and High Birth-Weight in Full-Term, Live Singleton Births in Wellington-Dufferin-Guelph in % Low Birthweight High Birthweight 3.5% % of Full-term Livebirths 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Source: Vital Statistics, 2002 Live Births Table, Provincial Health Planning Database, May Breastfeeding In 2001, slightly more than three-quarters (77%) of women in WDG who had given birth in the past five years reported breastfeeding or trying to breastfeed their baby 4. Of these, 14% had breastfed for 10 months or more, compared with 20% for all Ontario mothers who had given birth since Neural Tube Defects In the past nine years, there have only been 20 hospitalizations for neural tube defects in WDG. It is not recommended to calculate rates based on small numbers however rates for Ontario indicate that the incidence of neural tube defects is declining from one in every 1000 births in 1997 to one in every 2000 births in Data from the 2001 Canadian Community Health Survey indicate that 48% of women in WDG who gave birth in the past five years, reported taking folic acid during pregnancy. Folic acid supplements protect against neural tube defects. It is also possible to obtain the required folic acid from a healthy diet. Wellington-Dufferin-Guelph Public Health 27 of 36

28 2.8. Dental Health A module on oral health was included in the 2003 CCHS 4. Of the population 12 years and older, 22% felt that the health of their teeth and mouth was excellent, while 11% felt that it was fair or poor. The year age group was the least likely to report excellent oral health (14%) and more frequently reported that it was fair or poor (21%). Seniors (aged 65 years and older) were only slightly less likely to report excellent oral health (22%) and more likely to report it as fair or poor (13%) than the total population. In the 2003 Canadian Community Health Survey 4, 43% of WDG residents aged 12 years and older reported experiencing some oral/facial pain in the past month. In addition they reported many other oral or dental health problems, as illustrated in Figure 6.1 below. Figure Self-reported Oral Health Problems in Wellington-Dufferin-Guelph Residents (aged 12+ Years), with Highest and Lowest reported Frequency by Age Group Had bad breath past mo. Dry mouth past mo. Bleeding gums past mo. Had pain - mouth past mo. Lowest frequency Highest frequency Total 12+ yrs Had pain - jaw past mo. Teeth sensitive to hot/cold Toothache past mo. Inability to chew % of population 12+ yrs Source: 2003 Canadian Community Health Survey, electronic share file, weighted data, Ontario Ministry of Health and Long Term Care and Statistics Canada, Wellington-Dufferin-Guelph Public Health 28 of 36

29 Figure Self-reported Oral Health in Wellington-Dufferin-Guelph Residents (aged 12+ Years), with Highest and Lowest reported Frequency by Age Group Brushes < 2x/day Does not have own teeth years yrs Total 12+ yrs Wears dentures Last dental visit 5+ yrs ago Source: 2003 Canadian Community Health Survey, electronic share file, weighted data, Ontario Ministry of Health and Long-Term Care and Statistics Canada, Children in Need of Dental Treatment in WDG Public health units in Ontario offer financial assistance with the cost of urgent dental care for children of low-income families through the Children in Need of Treatment (CINOT) program. To qualify for CINOT, children must be under 14 years of age and be identified through dental screening as being at high risk of dental decay, i.e., they had an urgent dental condition that would cause pain or infection, if not treated in the next four weeks. In 2005, 1,085 children were identified as CINOT eligible through dental screenings in schools and clinics in WDG. This represented approximately 9% of all children screened from the moderate and high-risk schools included in the CINOT program. Wellington-Dufferin-Guelph Public Health 29 of 36

30 Section 3: How Healthy Will We Be in the Future? 3.1. Risk Factors for Chronic Disease and Injury That You Can Change The risk of death, regardless of the cause, increases with age. Since the population in WDG is aging as described in Section 1, the death rate is expected to increase over the next few decades. However, chronic disease and injury are also influenced by other risk factors that can be changed. If these risk factors increase in prevalence, then the rate of death and illness from the leading causes will be even higher than is projected because of the aging population. The risk factors of insufficient daily physical activity, inadequate fruit and vegetable consumption, tobacco use, exposure to environmental tobacco smoke (ETS), heavy alcohol consumption, and obesity are associated with increased incidence of heart disease, cancer, diabetes, respiratory diseases, and injury (particularly falls in the elderly). For example, Cancer Care Ontario reports that following recommended guidelines for tobacco use, diet, and physical activity could prevent about 60% of new cancer cases 11. As well, a recent 52-country research project reported that risk factors that can easily be changed, accounted for over 90% of heart attack risk. This finding applied to men and women, young and old, in all regions of the world 12. Table 3.1 compares the percentage of WDG residents aged years that reported these modifiable risk factors in 2001 and 2003 to the Cancer targets. Although there have been improvements in the prevalence of some of these risk factors between 2001 and 2003, particularly for women, the population remains at a high level of risk for chronic disease and injury. Table self-reported prevalence of modifiable risk factors for chronic disease and injury in year olds in Ontario and Wellington-Dufferin-Guelph, 2001 and Risk Factor Physical Inactivity Daily/Occasional Smoking Gender Cancer 2020 Target Ontario 2001 WDG 2001 WDG 2003 Males 10% 49% 47% 46% Females 10% 55% 55% 43% Males 5% 30% 31% 30% Females 5% 23% 25% 20% Consume < 5 Fruits or Males 10% 69% 60% 57% Vegetables daily Females 10% 58% 53% 43% Overweight/Obesity (Body Males 10% 69% 60% 54% Mass Index > 25) Females 10% 58% 63% 44% Males 6% 31% 30% 30% Heavy drinking Females 6% 11% 13% 13% Exposure to Second-hand Total 0% 25% 47% 22% Smoke (ETS) Source: 2003 Canadian Community Health Survey, Ontario electronic share file, weighted data, MOHLTC Targets from: Targeting Cancer: Cancer 2020 Summary Report, p.8, Canadian Cancer Society, Targeting Cancer: Cancer 2020 Summary Report, p.9, Canadian Cancer Society, Yusuf S, Hawken S, Ounpuu S, Dans T. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet, published online September 3, Targeting Cancer, p.8. Wellington-Dufferin-Guelph Public Health 30 of 36