NATIONAL SURVEILLANCE OF OSTEOARTHRITIS AND RHEUMTOID ARTHRITIS IN CANADA

Transcription

1 NATIONAL SURVEILLANCE OF OSTEOARTHRITIS AND RHEUMTOID ARTHRITIS IN CANADA Results from the Canadian Chronic Disease Surveillance System Public Health Agency of Canada, Ottawa, ON October 26, 2017 AAC 2017 Vancouver, BC

2 What will we discuss? 1. Health surveillance and how it benefits Canadians 2. Public Health Agency of Canada s Canadian Chronic Disease Surveillance System 3. National surveillance of osteoarthritis and rheumatoid arthritis in Canada Key figures: prevalence, incidence, all-cause mortality 2

3 What is health surveillance? Surveillance is the tracking of health events or health determinants through: Systematic, regular collection of best available data Analysis, interpretation and integration into surveillance products Dissemination to those who need to know It answers the questions: What happened? To what extent? To whom? When? Where? 3

4 What does health surveillance support? Public Health Actions Public Health Functions Surveillance provides evidence and information towards Response that supports Population Health Assessment Health Promotion Information Sources Planning Policy Development Disease & Injury Prevention Health Protection Emergency Preparedness & Response Surveillance Systems Data Sources Capacity Development 4

5 Scope of surveillance from local to global Local level Lab, clinic, hospital School, pharmacy, etc. Province/Territory (P/T) level Ministry of Health Federal level PHAC, Health Canada, other departments CIHI, Statistics Canada Global WHO, PAHO, OIE, OECD 5

6 How is surveillance of arthritis conducted in Canada? National Population Surveys Canadian Community Health Survey (Statistics Canada) Survey of Living with Chronic Diseases (Statistics Canada + PHAC) Health Administrative Data Canadian Chronic Disease Surveillance System (PHAC) 6

7 What is the Canadian Chronic Disease Surveillance System (CCDSS)? A collaborative network of P/T surveillance systems supported by the PHAC to track chronic diseases and the related burden to the health care system. It identifies chronic disease cases from P/T administrative health databases including physician billing claims and hospital discharge abstract records, linked to P/T health insurance registries. Case definitions are applied to these linked databases and data are then aggregated at the P/T level before being submitted to PHAC for reporting. 7

8 What are the objectives of the CCDSS? Create nationally comparable data: (fill data gaps) Epidemiology (incidence, prevalence, mortality) Health services utilization Complications/co-morbid conditions (already in CCDSS) Enhance capacity for chronic disease surveillance (enable analysis and reporting) Provincial / Territorial Federal 8

9 What are the surveillance priorities of the CCDSS? Priorities were set through the Public Health Network Task Group on Surveillance of Chronic Disease and Injury Criteria: Public health importance disease burden, interventions, strategies Relationship to conditions already in CCDSS start with complications/co-morbid conditions Data quality evidence that P/T admin case definitions are valid Feasibility consensus about case definition and a common national standard 9

10 What diseases/conditions are being tracked? Start year Disease/condition 1999 Diabetes 2010 Hypertension Mood and Anxiety Disorders Mental Illness 2012 Ischemic Heart Disease (including Acute Myocardial Infarction) Heart Failure Chronic Obstructive Pulmonary Disease Asthma 2013 Osteoporosis Osteoporotic Related Fractures 2014 Parkinsonism (including Parkinson s disease) 2015 Stroke Multiple Sclerosis Epilepsy 2017 Dementia (including Alzheimer s disease) Schizophrenia Osteoarthritis Rheumatoid Arthritis Under development Gout and Crystal Arthropathies Juvenile Idiopathic Arthritis Multimorbidities Economic Cost 10

11 How does the CCDSS work? PHAC Transform Software Arthritis Case Definition BC AB Arthritis Arthritis MB ON Arthriti Arthritis s SK Arthritis QC Arthritis NB PE NS NL Arthritis Arthritis Arthritis Arthritis Canada Arthritis Report NT Arthritis NU YT Arthritis Arthritis Insurance Registry Hospital Transform Software CCDSS Data Structure Arthritis Case Definition Arthritis P / T Arthritis Report Physician Billing P/T 11

12 What data does the CCDSS provide? Indicators Prevalence (counts and proportions) Incidence (counts and rates) All-cause mortality (counts, rates and rate ratios) By variables Sex Age group (5-year) P/T (Newfoundland excluded from RA estimates) Fiscal years to

13 OSTEOARTHRITIS (OA) 13

14 How is OA monitored in the CCDSS? Insurance Registry Hospital Database Physician Billing Database Unique ID Unique ID Unique ID Demographic Data Case Ascertainment Case Ascertainment Mortality Health Services Health Services IF 20+ years of age AND 1+ hospital records ICD-10: M15.x-M19.x OR 2+ physician claims (1+ day apart) in 5 years ICD-9(-CM): 715.x Incident case of diagnosed OA (first year, prevalent case afterward until death) OA validation study in British Columbia (Rahman et al., Int J Rheumatol, 2016) Population: Randomly selected patients with knee pain aged years who underwent assessment of OA in knee, hip and hands (n=171) 14 Reference standard: X-rays, MRI, self-report and American College of Rheumatology criteria

15 How many Canadians (20+ years) are affected by OA? Prevalence ( ) Incidence ( ) Over 3,714,000 (or 13.0%) Over 222,000 (or 8.9 per 1,000) 60% of prevalent cases are women 15.4% in women vs. 10.5% in men 57% of incident cases are women 10.2 in women vs. 7.5 in men per 1,000 per 1,000 Source: Public Health Agency of Canada, CCDSS data excluding YT, March

16 PREVALENCE (%) Prevalence of OA by age group and sex, Canada, >=85 Age group (years) Females Males Source: Public Health Agency of Canada, CCDSS data, excluding YT, March

17 INCIDENCE (per 1,000) Incidence of OA by age group and sex, Canada, >=85 Age group (years) Females Males Source: Public Health Agency of Canada, CCDSS data, excluding YT, March

18 Age-std. INCIDENCE (per 1,000) Age std. PREVALENCE (%) Age-std. PREVALENCE and INCIDENCE of OA among Canadians (20+ years), by P/T, to BC AB SK MB ON QC NB PE NS NL NT NU CA 2009/ / / / / BC AB SK MB ON QC NB PE NS NL NT NU CA 2009/ / / / /14 Source: Public Health Agency of Canada, CCDSS data excluding YT, March 2017; Estimates age-std. to the 2011 CA population. 18

19 Age-std. PREVALENCE and INCIDENCE of OA among Canadians (20+ years) by sex, to Age-std. PREVALENCE (%) Age-std. INCIDENCE (per 1,000) Fiscal Year Relative change in prevalence from to : Females: 5.0% Males: 8.1% Prevalence - females Prevalence - males Incidence - females Incidence - males Source: Public Health Agency of Canada, CCDSS data excluding YT, March 2017; Estimates age-std. to the 2011 CA population. 19

20 RHEUMATOID ARTHRITIS (RA) 20

21 How is RA monitored in the CCDSS? Insurance Registry Hospital Database Physician Billing Database Unique ID Unique ID Unique ID Demographic Data Case Ascertainment Case Ascertainment Mortality Health Services Health Services IF 16+ years of age AND 1+ hospital records ICD-10-CA: M05.x-M06.x OR 2+ physician claims (> 8 weeks apart) in 2 years ICD-9(-CM): 714.x Exclusion criterion: Subsequent to qualifying, cases with 2+ physician claims (1+ day apart) in 2 years with a diagnostic code for a non-ra inflammatory arthritides are excluded (modified version of Lacaille et al s, Arthritis Rheum, 2005). Incident case of diagnosed RA (first year, prevalent case afterward until death) RA validation study in Ontario (Widdifield et al., BMC MSK disorders 2014). Population: 20+ years; n= 69 and N = 7500; Prevalence= 0.9% Reference standard: Physician medical charts (EMRALD) 21

22 How many Canadians (16+ years) are affected by RA? Prevalence ( ) Incidence ( ) Over 368,700 (or 1.3%) Over 22,000 (or 0.8 per 1,000) 70% of prevalent cases are women 1.7% in women vs. 0.8% in men 67% of incident cases are women 1.0 in women vs. 0.5 in men per 1,000 per 1,000 Source: Public Health Agency of Canada, CCDSS data excluding YT and NL, March

23 PREVALENCE (%) Prevalence of RA by age group and sex, Canada, >=85 Age group (years) Females Males Source: Public Health Agency of Canada, CCDSS data, excluding YT and NL, March

24 Incidence of RA by age group and sex, Canada, INCIDENCE (per 1,000) >=85 Age group (years) Females Males Source: Public Health Agency of Canada, CCDSS data, excluding YT and NL, March

25 Age std. INCIDENCE (per 1,000) Age std. PREVALENCE (%) Age-std. PREVALENCE and INCIDENCE of RA among Canadians (16+ years), by P/T, to BC AB SK MB ON QC NB PE NS NT NU CA BC AB SK MB ON QC NB PE NS NT NU CA Source: Public Health Agency of Canada, CCDSS data excluding YT and NL, March 2017; Estimates age-std. to the 2011 CA population. 25

26 Age-std. PREVALENCE (%) Age-std. INCIDENCE (per 1,000) Age-std. PREVALENCE and INCIDENCE of RA among Canadians (16+ years) by sex, to Prevalence - females Fiscal Year Relative change in prevalence from to Females: 6.9% Males: 5.2% Prevalence - males Incidence - females Incidence - males Source: Public Health Agency of Canada, CCDSS data excluding YT and NL, March 2017; Estimates age-std. to the 2011 CA population. 26

27 Age-std. ALL-CAUSE MORTALITY (rate and rate ratio) among Canadians (16+ years) with and without RA, to Age-std. ALL CAUSE MORTALITY (per 1,000) Age-std. Rate Ratio Fiscal Year With RA Without RA Rate Ratio (with vs. without RA) 0.4 Source: Public Health Agency of Canada, CCDSS data excluding YT and NL, March 2017; Estimates age-std. to the 2011 CA population. 27

28 What are the strengths and limitations of CCDSS data? + Case definitions informed by validation studies + Close to complete coverage + Incidence and time trends Does not capture all eligible cases Potential to carry forward false positives with lifetime prevalence case definitions + Medically/clinically diagnosed conditions + Potential for data linkage with other data sources (e.g. EMR and Statistics Canada s surveys) 28

29 What s next? 1. Dissemination of OA and RA CCDSS data 2. Expand the CCDSS to include: Gout/crystal arthropathy Juvenile Idiopathic Arthritis Use of health services for all arthritis 3. Exploration of: Projections Multimorbidity 29

30 What are PHAC s dissemination methods (external)? Chronic Disease Update Mailing List (phac-aspc.gc.ca/cd-mc/maillist-eng.php) Webinars hosted by CHNET Public Health Infobase: (infobase.phac-aspc.gc.ca/index-en.html) CCDSS Data Cubes, Canadian Chronic Disease Indicators, Infographics & Data Blogs Reports, Factsheets, Peer-reviewed Papers (HPDCP Journal and other scientific journals) & Poster/Oral Presentations Social media Twitter (@PHAC_GC), Linkedin & Facebook Open Data (open.canada.ca/en/open-data) Canada.ca (canada.ca/en/public-health.html) & Partner Websites 30

31 Acknowledgements P/T Governments CCDSS Arthritis Working Group CCDSS Science Committee CCDSS Technical Working Group Public Health Agency of Canada Production Team 31

32 Questions? Siobhan O Donnell Centre for Surveillance and Applied Research Health Promotion and Chronic Disease Prevention Branch Public Health Agency of Canada (613)