Northwestern Health Unit Report on Alcohol Trends 2017

Transcription

1 Northwestern Health Unit Report on Alcohol Trends 2017

2 Table of Contents Table of Contents... 0 List of Figures... 1 Executive summary... 2 Introduction... 3 Low-risk drinking guidelines... 4 Heavy drinking... 5 Underage drinking... 7 Youth drinking patterns... 8 Alcohol use during pregnancy... 9 Emergency department (ED) visits from alcohol misuse Alcohol-attributable hospitalizations Motor vehicle collisions involving alcohol Discussion and limitations References Appendix 1: Data sources and analysis Appendix 2: Local Health Hubs... 20

3 List of Figures Figure 1: Proportion of population exceeding either of the low-risk drinking guidelines... 4 Figure 2: Proportion of population exceeding either of the low-risk drinking guidelines in the NWHU by age group, 2013/ Figure 3: Heavy drinking prevalence, / Figure 4: Proportion of the population engaging in heavy drinking in the NWHU by age group, 2013/ Figure 5: Underage drinking prevalence, / Figure 6: Maternal alcohol use during pregnancy, Figure 7: Maternal alcohol use during pregnancy in the NWHU by Local Health Hub area, combined Figure 8: Maternal alcohol use during pregnancy in the NWHU by age group, combined Figure 9: ED visits due to mental/behavioural disorders from alcohol use, age-standardized rates per 10,000, NWHU and Ontario, Figure 10: ED visits due to mental/behavioural disorders from alcohol use by Local Health Hub (LHH) area, combined rates per 10,000 per year (including FN reserves) Figure 11: ED visits due to mental/behavioural disorders from alcohol use by Local Health Hub (LHH) area, combined rates per 10,000 per year (excluding FN reserves) Figure 12: ED visits due to mental/behavioural disorders from alcohol use by age group and sex, rates per 10,000 per year, NWHU, combined Figure 13: Number of hospitalizations from chronic conditions attributable to alcohol use, NWHU, combined Figure 14: Number of injury-related hospitalizations attributable to alcohol use, NWHU, combined Northwestern Health Unit Report on Alcohol Trends,

4 Executive summary This report outlines key population health indicators related to alcohol use within the Northwestern Health Unit (NWHU) catchment area. Indicators related to frequency of alcohol use amongst the population are covered in the report, as well as information on youth alcohol consumption habits, maternal alcohol exposure during pregnancy, emergency department visits and hospitalizations in the area attributable to alcohol use. Comparisons to provincial statistics are provided where possible, as well as results for Local Health Hubs (LHHs) within the NWHU catchment area. Some of the key findings of the report include: Over 3 in 5 people (61.7%) in the NWHU area exceeded the low-risk alcohol drinking guidelines in 2013/14, which is statistically higher than the provincial rate of 45.3%. o The rate was highest in the younger population; 71.9% of those aged in the NWHU area exceeded the guidelines. o The rate was statistically higher amongst males; 61.8% vs 50.6% in females. The rate of heavy drinking is statistically higher in the NWHU area; 23.3% of the population partook in heavy drinking in 2013/14 compared to 17.9% of the provincial population. o Rates are higher in males, who have a rate of 29.3%, statistically higher than the female rate of 17.4%. In the NWHU area over half of the population (54.1%) aged partook in underage drinking in 2013/14, which is statistically higher than the provincial rate of 31.0%. 7.2% of mothers in the NWHU area consumed alcohol while pregnant in 2015, which is over twice as high as (and statistically different from) the provincial rate of 2.5%. o The rate was highest amongst mothers under 20 years old; 14.3%, which is statistically higher than the rates all other age groups. In 2015, the incidence rate of emergency department (ED) visits from alcohol misuse in the NWHU was per 10,000 people. This was over 6 times as high as the provincial rate of 44.0 per 10,000. The results of this analysis demonstrate the high burden of disease caused by alcohol consumption in the NWHU catchment area. These indicators provide valuable information for local program planning, and will continue to be tracked to evaluate the health status and needs of our population. Northwestern Health Unit Report on Alcohol Trends,

5 Introduction The Northwestern Health Unit Report on Alcohol Trends, 2017 report outlines local statistics and trends on alcohol use and the health outcomes related to alcohol use within the Northwestern Health Unit (NWHU) catchment area. The report outlines trends in indicators at the population level related to self-reported alcohol use, alcohol use amongst youth in the area and underage drinking, maternal alcohol use during pregnancy, and alcohol-attributable hospitalizations in the area amongst other related statistics. Where possible, statistics for the NWHU area are compared to provincial trends, and in some cases are stratified by Local Health Hub (LHH) area. These LHH s act as mini catchment areas within the larger NWHU catchment area, and provide a way to geographically group the communities in the area. More information about the LHHs can be found in Appendix 2. The objectives of the report are to: Provide statistics and examine recent trends in alcohol use and related health outcomes in the NWHU catchment area. Compare local and provincial trends. Provide meaningful information that can be used to help prioritize NWHU programs and services related to alcohol use. All of the data used in this report was extracted or referenced between June and August of Details about data sources of the indicators and how the data were analyzed can be found in the main body of the report, as well as in Appendix 1. Northwestern Health Unit Report on Alcohol Trends,

6 Low-risk drinking guidelines The Canadian Low-Risk Alcohol Drinking Guidelines (LRDG) are designed to help Canadians moderate their alcohol intake and reduce immediate and long-term harms related to alcohol use ( There are two guidelines: one guideline relates to long-term risk which recommends consuming no more than two drinks per day, 10 drinks per week for women and three drinks per day, 15 per week for men. The second guideline relates to immediate or short-term risk, and recommends that women consume no more than 3 drinks and men consume no more than 4 drinks on one occasion. In the NWHU catchment area over 3 out of 5 people (61.7%) reported in 2013/2014 that they exceeded either of these low-risk drinking guidelines. This is statistically higher than the provincial rate, which is 45.3% of the population. Rates in the NWHU area have generally been between 50-60% going back to Figure 1: Proportion of population exceeding either of the low-risk drinking guidelines 70% % exceeding either guideline 60% 50% 40% 30% 20% 10% 0% / / / /14 NWHU 51.4% 61.2% 52.4% 54.3% 52.2% 61.7% Ontario 42.6% 43.6% 42.3% 42.8% 44.4% 45.3% Source: Public Health Ontario. Snapshots: Self-reported rate of exceeding either low-risk alcohol drinking guidelines. Toronto, ON: Agency for Health Protection and Promotion; 2015 Dec 14 [cited 2016 May 26]. Available from: Note: Data excludes First Nations reserves A higher proportion of younger people exceed the low-risk drinking guidelines in the NWHU area. 71.9% of those aged exceeded either of the guidelines in 2013/14, compared with 57.7% in the age group and 31.3% in those 65 and older. The proportion in the 65+ age group was statistically lower than in both of the other age groups. Northwestern Health Unit Report on Alcohol Trends,

7 The proportion amongst males was higher than females in the NWHU area (61.8% vs. 50.6% in 2013/14), with the difference being statistically significant. Figure 2: Proportion of population exceeding either of the low-risk drinking guidelines in the NWHU by age group, 2013/14 % exceeding either guideline 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Age group Source: Public Health Ontario. Snapshots: Self-reported rate of exceeding either low-risk alcohol drinking guidelines. Toronto, ON: Agency for Health Protection and Promotion; 2015 Dec 14 [cited 2016 May 26]. Available from: Note: Data excludes First Nations reserves Heavy drinking Heavy drinking refers to the proportion of the population aged 12 and older who report having had five drinks or more on one occasion for males, four drinks or more for females, at least once a month in the past 12 months. In the NWHU area nearly a quarter of the population (23.3%) engaged in heavy drinking episodes in 2013/14. This figure has consistently been between 22-25% going back to 2003, and is statistically higher than the provincial rate which has been between 16-18% during the same time. Northwestern Health Unit Report on Alcohol Trends,

8 Figure 3: Heavy drinking prevalence, /14 % who partake in heavy drinking 30% 25% 20% 15% 10% 5% 0% / / / /14 NWHU 22.8% 25.9% 22.7% 23.8% 24.5% 23.3% Ontario 16.9% 17.6% 16.8% 17.1% 18.0% 17.9% Source: Public Health Ontario. Snapshots: Self-reported heavy drinking rate. Toronto, ON: Agency for Health Protection and Promotion; 2015 Dec 14 [cited 2016 May 26]. Available from: Note: Data excludes First Nations reserves The highest rates in the NWHU are in those aged 19-44, where almost a third (30.9%) reported heavy drinking in 2013/14. In those aged the figure was 20.8%, and in those aged 65 and older it was 10.2%, statistically lower than both of the younger age groups. The rate of heavy drinking is higher amongst males in the NWHU area: 29.3% compared with 17.4% in females in 2013/14, with the difference being statistically significant. Northwestern Health Unit Report on Alcohol Trends,

9 Figure 4: Proportion of the population engaging in heavy drinking in the NWHU by age group, 2013/14 45% 40% % reporting heavy drinking 35% 30% 25% 20% 15% 10% 5% 0% Age group Source: Public Health Ontario. Snapshots: Self-reported heavy drinking rate. Toronto, ON: Agency for Health Protection and Promotion; 2015 Dec 14 [cited 2016 May 26]. Available from: Note: Data excludes First Nations reserves Underage drinking In the NWHU area, over half of the population aged 18 and under (54.1%) engaged in underage drinking in 2013/14. This is statistically higher than the provincial rate which was 31.0%. Rates of underage drinking in the NWHU area have been around the same level since 2003, while rates in the province have been decreasing slightly over the same time. Due to high degrees of statistical uncertainty in the estimates, rates of underage drinking cannot be reported separately for males and females. In the province as a whole, the male rate in 2013/14 was 32.7%, which was slightly higher but not statistically different from the female rate of 29.2%. Northwestern Health Unit Report on Alcohol Trends,

10 Figure 5: Underage drinking prevalence, /14 60% % underage drinking 50% 40% 30% 20% 10% 0% / / / /14 NWHU 56.1% 51.5% 51.1% 47.2% 48.1% 54.1% Ontario 42.3% 41.7% 39.8% 37.2% 36.6% 31.0% Source: Public Health Ontario. Snapshots: Self-reported underage drinking rate. Toronto, ON: Agency for Health Protection and Promotion; 2015 Dec 14 [cited 2016 May 26]. Available from: Note: Data excludes First Nations reserves Youth drinking patterns Provincially just under half (45.8%) of high school students in grades 7-12 report using alcohol in the past 12 months (Boak et al., 2015). In Northern Ontario this figure is slightly higher (but statistically significant), at 52.1%, a figure which has been gradually decreasing in the past decade. Local survey data shows that young people in our region start drinking at an early age and consume alcohol frequently. Of grade 9-12 students in the NWHU area who had ever used alcohol in the past, 76.5% claimed to be under the age of 15 years old when they had their first drink of alcohol and 33.4% had their first drink before the age of 13 (COMPASS, 2015). The Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) indicates that the average age of initiation for the consumption of alcohol was 16.2 years in Across the province, 10.2% of students in grades 9-12 drink only once a month or less and 15.3% drink at least 2-3 times per month or more (Boak et al., 2015). Locally, in the NWHU area 21.6% all students in grades 9-12 drink alcohol at least 2 or 3 times per month. 9.2% of all students report that they drink alcohol at least once a week (COMPASS, 2015). For grade 9-12 students who had ever used alcohol in the NWHU area, 76% NWHU have had 5 or more drinks on at least one occasion in the past 12 months (COMPASS, 2015). Northwestern Health Unit Report on Alcohol Trends,

11 Alcohol use during pregnancy While in hospital mothers in Ontario are asked about various behaviours during pregnancy, including alcohol consumption. This indicator refers to the proportion of mothers that consumed any alcohol during the course of their pregnancy. This data is extracted from the Better Outcomes Registry Network (BORN). Due to data sharing issues, any data from BORN at the present time does not include mothers who reside on First Nations reserves in the area. In 2015, 7.2% of mothers in the NWHU area had consumed alcohol during their pregnancy. This is statistically higher than the provincial figure for 2015 which is 2.5%. It was also a statistically significant increase from the NWHU rate 2 years prior in 2013, which was 2.9%. Figure 6: Maternal alcohol use during pregnancy, % 9% % who consumed alcohol 8% 7% 6% 5% 4% 3% 2% 1% NWHU Ontario 0% Source: BORN Information System Extracted January 15, 2016 Note: Data excludes First Nations reserves There was some variation of maternal alcohol use when looking at the data by Local Health Hub (LHH) area, although due to small numbers there tends to be a high degree of uncertainty around the estimates. Alcohol exposure was statistically lower in the Dryden area when compared with the all-municipality combined rate. Northwestern Health Unit Report on Alcohol Trends,

12 Figure 7: Maternal alcohol use during pregnancy in the NWHU by Local Health Hub (LHH) area, combined % who used alcohol 16% 14% 12% 10% 8% 6% 4% 2% 0% Ontario NWHU Sioux Lookout Red Lake Kenora Fort Frances, Emo, Rainy River, Atikokan Dryden Source: BORN Information System Extracted January 15, 2016 Note: Data excludes First Nations reserves The maternal age group with the highest rates of alcohol use during pregnancy is those under 20. Between 2013 and 2015, 14.3% of mothers under 20 consumed alcohol during pregnancy, more than twice as high as any other age group, with the differences being statistically significant. Figure 8: Maternal alcohol use during pregnancy in the NWHU by age group, combined 25% % with alcohol exposure 20% 15% 10% 5% 0% < Age group Source: BORN Information System Extracted January 15, 2016 Note: Data excludes First Nations reserves Northwestern Health Unit Report on Alcohol Trends,

13 Emergency department (ED) visits from alcohol misuse In the NWHU catchment area, there were 1,791 visits to the ED due to mental/behavioural disorders from alcohol use in This includes conditions such as acute intoxication, withdrawal state, dependence syndrome, amongst others. This works out to be an incidence rate of per 10,000 people that year (in the 10+ population), which is over six times as high as the provincial rate of 44.0 per 10,000 with the difference being statistically significant. Figure 9: ED visits due to mental/behavioural disorders from alcohol use, agestandardized rates per 10,000, NWHU and Ontario, Age-standardized rate per 10, NWHU Ontario Source: Ambulatory Emergency , Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Date Extracted: Dec 15, Looking at ED visits by Local Health Hub (LHH) area, there are significant differences in rates across the region. The Sioux Lookout LHH had the highest incidence of ED visits in the five years between 2011 and 2015, with a rate of visits per 10,000 per year. This is statistically higher than the rates in all of the other LHH areas in the region. The lowest rate was in the Emo LHH, with 78.5 ED visits per 10,000 per year. Atikokan and Dryden also had low rates compared to the rest of the region. This data represents the entire NWHU catchment area, including First Nations (FN) reserves in the region, and is outlined in Figure 10 below. Figure 11 shows the same data, but only for offreserve communities in the catchment areas and excluding FN reserves. Northwestern Health Unit Report on Alcohol Trends,

14 Figure 10: ED visits due to mental/behavioural disorders from alcohol use by Local Health Hub (LHH) area, combined rates per 10,000 per year (including FN reserves) Age-standardized rate per 10, Ontario NWHU catchment area Sioux Lookout Kenora Rainy River Red Lake Fort Frances Dryden Atikokan Emo Source: Ambulatory Emergency , Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Date Extracted: Dec 15, Figure 11: ED visits due to mental/behavioural disorders from alcohol use by Local Health Hub (LHH) area, combined rates per 10,000 per year (excluding FN reserves) 500 Age-standardized rate per 10, Ontario NWHU catchment area Sioux Lookout Kenora Rainy River Red Lake Fort Frances Dryden Atikokan Emo Source: Ambulatory Emergency , Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Date Extracted: Dec 15, Northwestern Health Unit Report on Alcohol Trends,

15 Rates of ED visits from alcohol misuse in the NWHU area are higher amongst males. Between 2011 and 2015 the rate in males was per 10,000 per year, which was statistically higher than the rate in females which was per 10,000 per year. Overall, the highest rate during this time was in males in their thirties, where the rate was per 10,000 per year. Figure 12: ED visits due to mental/behavioural disorders from alcohol use by age group and sex, rates per 10,000 per year, NWHU, combined ED visits per 10,000 per year Age group Males Females Source: Ambulatory Emergency , Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Date Extracted: Dec 15, Alcohol-attributable hospitalizations Alcohol-attributable hospitalizations are defined as the number of inpatient discharges within a population that are caused by alcohol use. The indicator is estimated by calculating the alcoholattributable fraction (AAF) for certain alcohol-related diseases or conditions (i.e. cirrhosis of the liver). The number of hospitalizations caused by alcohol is calculated separately for each disease, and added up to get the total number that are caused by alcohol use. The indicator is calculated using the method outlined on the Association of Public Health Epidemiologists in Ontario (APHEO) website: In the NWHU area, in the five years between 2011 and 2015, there were 7,542 hospitalizations due to chronic diseases and injuries for the population aged years old. Of these, an estimated 1,343 (17.8%) were attributable to alcohol use. During this five years, there were on average an estimate of 265 alcohol-attributable hospitalizations per year in the catchment area, which works out to be an incidence rate of 468 per 100,000 per year. Incidence rates during this time were significantly higher in males than females: per 100,000 per year for males, statistically higher than the female rate of per 100,000 per year. Northwestern Health Unit Report on Alcohol Trends,

16 Over these five years, some of the leading causes of alcohol-attributable hospitalizations included alcoholic psychoses (acute intoxication, withdrawal, etc.), epilepsy, alcohol abuse, cirrhosis, unintentional injuries, assault and intentional self-harm. Figure 13: Number of hospitalizations from chronic conditions attributable to alcohol use, NWHU, combined Alcoholic psychoses Epilepsy Alcohol abuse Alcohol dependence syndrome Cirrhosis Alcoholic gastritis Acute and chronic pancreatitis Cardiac arrhythmias Hypertensive disease # alcohol-attributable hospitalizations Females Males Sources: Inpatient Discharges , Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Date Extracted: June 7, 2016; OMHRS , Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Date Extracted: June 7, 2016 Note: the numbers in this chart are derived estimates, calculated using the method outlined on the Association of Public Health Epidemiologists in Ontario (APHEO) website: Northwestern Health Unit Report on Alcohol Trends,

17 Figure 14: Number of injury-related hospitalizations attributable to alcohol use, NWHU, combined Other unintentional injuries Falls Assault Intentional self-harm Motor vehicle collisions Females Males Sources: Inpatient Discharges , Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Date Extracted: June 7, 2016; OHMRS , Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Date Extracted: June 7, 2016 Note: the numbers in this chart are derived estimates, calculated the method outlined on the Association of Public Health Epidemiologists in Ontario (APHEO) website: Motor vehicle collisions involving alcohol According to the Ontario Ministry of Transportation (MTO), between 2009 and 2013 there were 245 motor vehicle collisions in the Kenora and Rainy River Districts that involved drinking drivers (note: a small proportion of the Kenora District population is within the Thunder Bay District Health Unit catchment area). This is an average of about 49 collisions per year in the area. Overall, in the NWHU catchment area, between 2011 and 2015 there were 165 hospitalizations from motor vehicle collisions (traffic collisions only). Based on previous studies, of these 165 hospitalizations, an estimated 26% (43 hospitalizations) can be attributed to alcohol use (Rehm, K., Room, R. et al., 2004). Northwestern Health Unit Report on Alcohol Trends,

18 Discussion and limitations Some of the trends outlined in this report indicate that levels of alcohol use and the health outcomes related to alcohol use are issues of concern within the NWHU catchment area. Generally speaking, rates of alcohol use are very high in the area compared to the rest of Ontario when looking at self-reported data. Additionally, more people are hospitalized from alcohol misuse in NWHU compared to the rest of the province. With regard to alcohol use, a higher proportion of people in the NWHU area exceed the low-risk drinking guidelines compared to the province as a whole. Also, a higher proportion of the population partakes in heavy drinking, and there are higher rates of underage drinking amongst youth in the catchment area. There are also higher rates of alcohol use amongst pregnant women in the area. The rate of ED visits from alcohol misuse in the NWWHU area is over 6 times as high as the provincial rate. This is especially a problem amongst males in the area, whose rates are statistically higher than rates in females. Overall, alcohol use has played a major role in chronic disease and injury-related hospitalizations in the catchment area. Between 2011 and 2015 there were over 1,300 hospitalizations estimated to have been caused by alcohol which accounts for over 1 in 6 of all chronic disease and injury-related hospitalizations during that time period. One of the limitations in this report is that some of the data (i.e. self-reported alcohol use stats) is only available at the catchment area-level. This means that the data cannot be broken down by municipality, which is valuable information to have. Similarly, due to small sample sizes, some of the estimates had to be calculated by combining multiple years of data. While this gives more robust estimates, it takes away the ability to examine annual trends. Another limitation to consider with the self-reported data in this report is that this type of data always carries a risk of introducing information bias into the estimates, as individuals may inaccurately report their health-related habits Another limitation is that some of the data (all of the self-reported alcohol use stats) excludes populations that live on First Nations reserves within the catchment area. In the NWHU area, this is a significant proportion of the population (nearly a quarter). As a result, these indicators are only representative of the off-reserve population in the NWHU, but not of the entire population living within the catchment area. These statistics are intended to provide local, relevant information about alcohol-related trends that can be used to inform public health planning at the population level. The NWHU routinely monitors these types of indicators to identify priority areas and to look for changing trends over time. Northwestern Health Unit Report on Alcohol Trends,

19 References Boak, A., Hamilton, H.A., Adlaf, E.M., & Mann, R.E. (2015). Drug use among Ontario students, : Detailed OSDUHS findings (CAMH Research Document Series No. 41). Toronto, ON: Centre for Addiction and Mental Health. Canadian Alcohol and Drug Use Monitoring Survey. (2012). Summary of Results for Retrieved from: Canadian Centre on Substance Abuse. Drinking Guidelines. Retrieved from: Rehm, J., Room, R., et al. (2004). Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. World Health Organization. Northwestern Health Unit Report on Alcohol Trends,

20 Appendix 1: Data sources and analysis All of the data used in this report were extracted between June and August 2016, and came from Public Health Ontario s Snapshots Tool, COMPASS, IntelliHEALTH Ontario and the Better Outcomes Registry Network (BORN) Information System. Snapshots Snapshots is an online interactive tool designed by Public Health Ontario, available at The tool provides geographical and temporal trends for key public health indicators at the public health unit level in Ontario, and is based on Core Indicators developed by the Association of Public Health Epidemiologists in Ontario (APHEO). COMPASS The COMPASS Study is a nine-year longitudinal study conducted in schools in Ontario that began in The study measures youth health behaviours in students in grades 9-12 throughout the province, and is led by researchers at the University of Waterloo in collaboration with researchers at the University of Alberta, the University of British Columbia and the University of Toronto. IntelliHEALTH Ontario IntelliHEALTH Ontario is a provincial portal maintained by the Ministry of Health and Long-Term Care, which pulls together administrative data from several databases, including Vital Statistics, National Ambulatory Care Reporting System (NACRS), Discharge Abstract Database (DAD) and Statistics Canada. The portal can be accessed by authorized users who use the data for analysis and planning of healthcare delivery in Ontario. BORN Information System BORN Ontario is a provincial program funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC) and supported by the Children s Hospital of Eastern Ontario (CHEO) that was established in The objective of BORN Ontario was to be a source of accurate and timely information to monitor, evaluate and plan for the health of mothers and children. The new BORN Information System (BIS) was launched in 2012, with over 100 hospitals and 84 midwifery practice groups contributing data and capturing 100% of all hospital births in Ontario, as well as 100% of home births attended by midwives. Northwestern Health Unit Report on Alcohol Trends,

21 Data Analysis All data analyses for this report were conducted using Microsoft Excel, STATA and Open Epi. Confidence intervals for proportion-based indicators were calculated using the Mid-P Exact method. Tests for statistical differences between proportions were carried out by calculating the odds ratio using the Mid-P Exact method. Results were considered statistically significant if the 95% confidence interval around the calculated odds ratio did not contain 1. Age-standardized incidence rates were calculated using the 1991 Canadian Census Population. The rates and 95% confidence intervals were calculated using the Poisson approximation of the binomial distribution, a method described here: Differences in compared rates were considered statistically significant if the 95% confidence intervals did not overlap. Northwestern Health Unit Report on Alcohol Trends,

22 Appendix 2: Local Health Hubs A Local Health Hub (LHH) refers to a health service delivery area where most or all sectors of the health system are linked in order to improve patient access The Northwest Local Health Integration Network (NW LHIN) is comprised of five Integrated District Networks (IDN s), and within these IDN s there are a total of 14 LHH s. Eight of these LHH s fall within the NWHU catchment area, while the others fall within the Thunder Bay District Health Unit (TBDHU) catchment area.the Sioux Lookout LHH falls partly with the NWHU catchment area, and partly within the TBDHU catchment area. For this analysis, only communities that fall within the NWHU catchment area were included. Atikokan Local Health Hub: CSD/Community Type of CSD Population (2015) Atikokan Township 2,747 Seine River 23A First Nation Reserve 272 Seine River 23B First Nation Reserve 0 Neguaguon Lake 25D First Nation Reserve 195 LHH Total 3,214 Data source: Population Estimates Ministry of Health and Long-Term Care. IntelliHEALTH Ontario. Date Extracted: January 10, Dryden Local Health Hub: CSD/Community Type of CSD Population (2015) Dryden City 7,941 Wabigoon Lake 27 First Nation Reserve 194 Machin First Nation Reserve 964 Eagle Lake 27 First Nation Reserve 241 Ignace Township 1,263 LHH Total 10,603 Data source: Population Estimates Ministry of Health and Long-Term Care. IntelliHEALTH Ontario. Date Extracted: January 10, Emo Local Health Hub: Includes Emo, Sabaskong Bay (Part) 35C, Chapple, and Manitou Rapids 11 CSD/Community Type of CSD Population (2015) Emo Township 1,218 Sabaskong Bay (Part) 35C First Nation Reserve 0 Chapple Township 731 Manitou Rapids 11 First Nation Reserve 309 LHH Total 2,258 Data source: Population Estimates Ministry of Health and Long-Term Care. IntelliHEALTH Ontario. Date Extracted: January 10, Northwestern Health Unit Report on Alcohol Trends,

23 Fort Frances Local Health Hub: CSD/Community Type of CSD Population (2015) Fort Frances Town 7,810 Alberton Township 846 La Vallee Township 963 Couchiching 16A First Nation Reserve 769 Rainy Lake 17A First Nation Reserve 212 Rainy Lake 17B First Nation Reserve 5 Rainy Lake 18C First Nation Reserve 95 Rainy Lake 26A First Nation Reserve 156 LHH Total 10,856 Data source: Population Estimates Ministry of Health and Long-Term Care. IntelliHEALTH Ontario. Date Extracted: January 10, Rainy River Local Health Hub: CSD/Community Type of CSD Population (2015) Rainy River Township 834 Big Grassy River 35G First Nation Reserve 247 Dawson Township 549 Morley Township 467 Rainy River, Unorganized Unorganized 1,176 Lake of the Woods Township 291 Big Island Mainland 93 First Nation Reserve 0 Long Sault 12 First Nation Reserve 36 Saug-a-Gaw-Sing 1 First Nation Reserve 119 LHH Total 3,719 Data source: Population Estimates Ministry of Health and Long-Term Care. IntelliHEALTH Ontario. Date Extracted: January 10, Red Lake Local Health Hub: CSD/Community Type of CSD Population (2015) Red Lake Municipality 4,859 Ear Falls Township 1,082 Wabauskang 21 First Nation Reserve 79 LHH Total 6,020 Data source: Population Estimates Ministry of Health and Long-Term Care. IntelliHEALTH Ontario. Date Extracted: January 10, Northwestern Health Unit Report on Alcohol Trends,

24 Kenora Local Health Hub: CSD/Community Type of CSD Population (2015) Kenora City 16,023 Sioux Narrows-Nestor Falls Township 759 Whitefish Bay 32A First Nation Reserve 691 Whitefish Bay 33A First Nation Reserve 81 Whitefish Bay 34A First Nation Reserve 132 Shoal Lake (Part) 39A First Nation Reserve 401 Shoal Lake (Part) 40 First Nation Reserve 104 Shoal Lake 34B2 First Nation Reserve 101 Rat Portage 38A First Nation Reserve 378 The Dalles 38C First Nation Reserve 200 Kenora 38B First Nation Reserve 407 Kenora, Unorganized Unorganized 7,384 Northwest Angle 33B First Nation Reserve 90 English River 21 First Nation Reserve 659 Wabaseemoong First Nation Reserve 851 Lake of the Woods 37 First Nation Reserve 48 Sabaskong Bay (Part) 35C First Nation Reserve 0 Sabaskong Bay 35D First Nation Reserve 402 LHH Total 28,711 Data source: Population Estimates Ministry of Health and Long-Term Care. IntelliHEALTH Ontario. Date Extracted: January 10, Northwestern Health Unit Report on Alcohol Trends,

25 Sioux Lookout Local Health Hub: CSD/Community Type of CSD Population (2015) Bearskin Lake First Nation Reserve 406 Cat Lake 63C First Nation Reserve 501 Deer Lake First Nation Reserve 777 Kee-Way-Win First Nation Reserve 346 Lac Seul 28 First Nation Reserve 906 MacDowell Lake First Nation Reserve 0 Muskrat Dam Lake First Nation Reserve 266 Neskantaga First Nation Reserve 242 North Spirit Lake First Nation Reserve 266 Osnaburgh 63B First Nation Reserve 436 Pickle Lake Township ** 444 Pikangikum 14 First Nation Reserve 2,290 Poplar Hill First Nation Reserve 509 Sachigo Lake 1 First Nation Reserve 428 Sandy Lake 88 First Nation Reserve 1,880 Sioux Lookout Municipality 5,222 Slate Falls Settlement 197 Weagamow Lake First Nation Reserve 826 LHH Total 15,942 Data source: Population Estimates Ministry of Health and Long-Term Care. IntelliHEALTH Ontario. Date Extracted: January 10, ** Report corrected to identify Pickle Lake as a Township Northwestern Health Unit Report on Alcohol Trends,