Deliverables: Population Health
Our Children, Our Future: The Health and Well-being of First Nations Children in Manitoba
Chartier M, Brownell M, Star L, Murdock N, Campbell R, Phillips-Beck W, Meade C, Au W, Schultz J, Bowes JM, Cochrane B
The purpose of this report is to provide a sound baseline measure of how First Nations children are doing in order to determine if children’s lives are improving as a result of the Truth and Reconciliation Commission’s Calls to Action. The present report was requested by the Healthy Child Committee of Cabinet to focus on First Nations children in Manitoba and to provide valuable information on their health and well-being – similar to Child Health Atlas reports previously prepared by Manitoba Centre for Health Policy (MCHP). The research team includes members from MCHP, First Nations Health and Social Secretariat of Manitoba (FNHSSM) and Manitoba First Nations Education Resource Centre (MFNERC). The analyses provide comparisons between First Nations children and all other Manitoba children, comparisons between on and off reserve First Nations, and regional comparisons by Regional Health Authority and by Tribal Council Areas. Large disparities between First Nations children and other Manitoba children were found in birth outcomes, physical health, mental health, health & prevention services, education, social services, justice system involvement and mortality. These results must be understood within the broader historical, social, legal and political context.Methamphetamine Use in Manitoba: A Linked Administrative Data Study
Nickel NC, Chartier M, McDonald N, Sarkar J, Dragan R, McCulloch S, Burchill C, Reimer J, Green C, Jones J, Sanguins J
This study identified Manitobans who had their methamphetamine use documented in whole-population, administrative health data for the years 2013 to 2018. This was achieved using the following databases housed within the Manitoba Population Research Data Repository: Hospital Discharge Abstracts, Medical Claims, Emergency Department Information System (EDIS), Winnipeg Fire and Paramedic Service (WFPS), and Diagnostic Services Manitoba (DSM). The study results include demographic and geographic mapping information, prevalence and risk ratios for mental health comorbidities (e.g. mood or anxiety disorders, substance use disorders), and rates of health service use (e.g. fire and paramedic services, physician visits, emergency department visits).The Diversity of Immigrants to Manitoba, Migration Dynamics and Basic Healthcare Service Use
Urquia M, Walld R, Prior H, Detillieux G, Eze N, Koseva I
Immigration is a key part of the Canadian social fabric. However, little is known about the characteristics of immigrants to Manitoba, as well as their social and health needs. The addition of the Immigration, Refugees and Citizenship Canada (IRCC) permanent resident database into the Manitoba Population Research Data Repository (Repository) at MCHP is the first step in addressing these gaps. This deliverable describes the linkage and the characteristics of international and interprovincial migrants. It also compares their basic primary care use and mortality with those of non-immigrants.Type 2 Diabetes in Manitoba
Ruth C, Sellers E, Chartrand C, McLeod L, Prior H, Sirski M, Dragan R, Chen H, McDougall C, Schultz J
This deliverable, undertaken in partnership with The First Nation Health and Social Secretariat of Manitoba provides an analysis of trends in incidence and prevalence of for all types of non-gestational diabetes from the 1985 to 2017 allowing comparison to national and international statistics. Then, using the wealth of data within the Repository, especially the Diabetes Education Resource for Children and Adolescents (DER-CA) clinical database, Manitobans diagnosed with type 2 diabetes mellitus (T2DM) were identified and their outcomes over the last 6 years were described. This includes diabetes control, complications, mortality and health service use including hospitalizations, continuity of primary care and specialist care. Multiple analyses were undertaken to examine whether the care received by Manitobans living with T2DM met current guidelines. There are also a number of special analyses in cohorts of people matched to those without diabetes for childhood onset T2DM, T2DM in pregnancy, and for mental health outcomes in adults. Information is presented for different age groups, by sex, by health region and by Tribal Council Area and results were compared between registered First Nation Manitobans and all other Manitobans.
The Health Status of and Access to Healthcare by Registered First Nation Peoples in Manitoba
Katz A, Avery Kinew K, Star L, Taylor C, Koseva I, Lavoie J, Burchill C, Urquia M, Basham A, Rajotte L, Ramayanam V, Jarmasz J, Burchill S
This deliverable is the product of a strong and developing relationship between MCHP and the First Nations Health and Social Secretariat of Manitoba. It looks at health and healthcare use patterns of First Nations people living in Manitoba. The analyses provide comparisons between First Nations and all other Manitobans, comparisons between on and off reserve First Nations, and regional comparisons by Regional Health Authority and by Tribal Council Areas. It is the first study to use the Regional Health Survey which includes on-reserve First Nation peoples. The results demonstrate the widening gap between the health of First Nations and all other Manitobans and point to inequities in service provision.
Exploring Tuberculosis Treatment, Management, and Prevention in Manitoba's Administrative Health Data
Lix LM, Plourde PJ, Larcombe L, Kinew KA, Basham CA, Derksen S, Srisakuldee W, Schultz J, McCulloch S
This report, produced in collaboration with First Nations partners, linked the Manitoba Tuberculosis (TB) Registry to other administrative health databases to investigate the health, healthcare use, and outcomes of people with active TB disease. In addition, we examined the health and outcomes of people receiving treatment for a latent (i.e., sleeping) TB infection; these people were identified from Manitoba’s prescription drug data. We looked at all active TB cases and treated latent TB cases in Manitoba spanning 15 years (1999-2014). People with active TB had high rates of health service use around the time of diagnosis. Persons with latent TB demonstrated treatment completion rates that may not be high enough to prevent TB from spreading, suggesting a need for better treatments that make it easier for patients to complete their treatment. The data tell us that there is still room for improvement in many areas to help identify persons with active and latent TB across Manitoba as early as possible. As well, funding for new technology and research is essential to help with monitoring new TB cases, so that healthcare providers can act quickly to curb the spread of TB. Manitoba has the highest rate of TB of all Canadian provinces. With adequate funding and the support of partners in TB monitoring and care, the goal of TB elimination in Manitoba is realistic.Mental Illness Among Adult Manitobans
Chartier M, Bolton J, Mota N, MacWilliam L, Ekuma O, Nie Y, McDougall C, Srisakuldee W, McCulloch S
Mental illness is prevalent across Manitoba and Canada. Statistics Canada reports that 20% of Canadians will experience a mental illness in their lifetime. This Manitoba report provides valuable background information on the burden of mental illness in the province and some insight into the longer-term associations between childhood/adolescent mental illness and adverse adult outcomes. Specifically, we examined the diagnostic prevalence of mental illness among adults in Manitoba, as well as the healthcare use and justice system involvement of adults with mental illness. To address the mental health needs of certain populations who may be at higher risk of mental illness, this report presents the prevalence in specific populations of Manitoba. A cohort of Manitobans born in the province was also developed to examine the relationship between childhood/adolescent mental disorders and adverse adult outcomes. The findings of this report will be important for planning services and programs to diagnose and treat mental illness. Coordinating services among government departments, including health, social services, education and justice, will also go a long way towards ensuring better care for Manitobans at risk for and suffering from mental illness. Finally, supporting mental health research is an essential part of understanding what works and what is needed to strengthen mental health services for Manitobans.Health and Social Outcomes Associated with High-Risk Alcohol Use
Nickel NC, Bolton J, MacWilliam L, Ekuma O, Prior H, Valdivia J, Leong C, Konrad G, Finlayson G, Nepon J, Singal D, Burchill S, Walld R, Rajotte L, Paille M
Alcohol is enjoyed by many Canadians and has special social and cultural significance in Canadian society. However, over-consumption of alcohol is linked with many, far-reaching harms. Recent data suggest that one in five Canadian drinkers exceed Canada’s low-risk drinking guidelines. This study examined high-risk drinking behaviours and associated outcomes among Manitobans. We used linked data housed in the Manitoba Population Research Data Repository to answer the following questions: (1) How many Manitobans are drinking more alcohol than is recommended by Canada’s low-risk drinking guidelines and has this number changed over time? (2) How many Manitobans have been diagnosed with an Alcohol Use Disorder over the past 20 years? (3) What are the patterns in healthcare utilization, social service use, and interactions with the justice system among individuals with a diagnosed Alcohol Use Disorder? Our analyses suggest several opportunities where supports can be put in place sooner to help Manitobans who are dealing with harmful consequences of high-risk drinking.
Care of Manitobans Living with Chronic Kidney Disease
Chartier M, Dart A, Tangri N, Komenda P, Walld R, Bogdanovic B, Burchill C, Koseva I, McGowan K-L, Rajotte L
Rates of kidney failure or end stage kidney disease (ESKD) have been steadily increasing with the prevalence of diabetes and the aging population in Manitoba. The purpose of this report was to gain a greater understanding of chronic kidney disease (CKD) and ESKD in adults and children in the province. The findings will provide background knowledge to prevent new cases of CKD, to intervene early to slow the progression to ESKD and to plan resources for kidney health services in the future. Manitoba Health, Healthy Living and Seniors asked Manitoba Centre for Health Policy to answer the following research questions: a) What are the future needs for kidney health services (peritoneal dialysis, home hemodialysis, in-centre dialysis and kidney transplant) in Manitoba? b) What is the geographic distribution of this population? c) What are the characteristics of the future population of Manitoba residents who will require renal replacement treatment? d) What preventive, screening, and education measures and affiliations with existing programs, might reduce the number of Manitobans who will require dialysis?Long-Term Outcomes Of Manitoba's Insight Mentoring Program: A Comparative Statistical Analysis
Ruth C, Brownell M, Isbister J, MacWilliam L, Gammon H, Singal D, Soodeen R, McGowan K, Kulbaba C, Boriskewich E
The objective of this report is to examine the outcomes of women and their children who have been involved in the Manitoba InSight program, an intensive mentoring program for women at high risk of having children with Fetal Alcohol Spectrum Disorder (FASD). By linking the clinical data within the InSight program database to the MCHP Repository we examined outcomes both during and after the program, with over 10 years of outcomes for earlier participants. We evaluated the impact on the mental, physical and perinatal health of the women and their children and their involvement with services such as social housing, Families First, prenatal care and Child and Family Services. This report will allow for planning and support of ongoing services to this at risk population and act as a baseline for further studies into FASD and its prevention and management.The Cost of Smoking: A Manitoba Study
Martens P, Nickel N, Forget E, Lix L, Turner D, Prior H, Walld R, Soodeen RA, Rajotte L, Ekuma O
This study focused on estimating the excess burden that smoking places on the healthcare system. We used survey data (i.e., Manitoba Heart Health Survey, National Population Health Survey, and the Canadian Community Health Survey) from over 45,000 Manitobans to measure individuals' smoking behaviours. We then linked individuals' survey data with their administrative health data held in the Population Health Research Data Repository. We followed survey respondents for ten years after survey to measure the excess healthcare use and expenditures associated with smoking. Smoking rates have decreased from 1989 to 2011. The study found that smoking is associated with increased physician visits, hospitalizations, and prescription drugs. This increased healthcare use translates into excess annual costs: $39M in physician costs, $40M in prescription drugs, $147M in hospital-related expenses, and $18M in cancer-related costs for a total costs of $244 million a year.
Adult Obesity in Manitoba: Prevalence, Associations, and Outcomes
Fransoo R, Martens P, Prior H, Chateau D, McDougall C, Schultz J, McGowan K, Soodeen R, Bailly A
Obesity doesn't kill people directly but is related to the development of a number of poor health outcomes, including high blood pressure and diabetes. These are important because they cause serious problems themselves, and they're related to heart disease and stroke, which are leading causes of death. The scope of the deliverable is to include the analysis of provincial trends of obesity and related chronic diseases over a 10-year period. The findings indicate the impact on the healthcare system from obese and overweight people may not be as significant as expected. Using nationally-administered health surveys from 1989 to 2008 the study found obesity rates increased in Manitoba. Overall, more than a quarter of people in the province are now considered obese. This report also confirms what's been proven in the past - geography, marital status, employment, age, sex, education, smoking, and physical activity level can influence weight.Manitoba Immunization Study
Hilderman T, Katz A, Derksen S, McGowan K, Chateau D, Kurbis C, Allison S, Reimer JN
Researchers from MCHP completed The Manitoba Immunization Study, the most comprehensive analysis of Manitoba's immunization programs ever performed. They looked at childhood and adult immunization rates in the province from April 1, 2000 to March 31, 2008, the impact of immunizations and the safety of vaccines. Overall, immunization rates for two-year-old children in Manitoba were stable over the eight years studied. The study looked at shots for flu and pneumonia in adults with a specific focus on three groups: pregnant women and women with a newborn, people older than 64, and people with chronic illness like diabetes. Manitobans 65 and over have the highest rate of immunizations and people with chronic illness have higher immunization rates than those without illness. Flu immunization reduced hospitalization and mortality in those over 65. The researchers also noted that nothing in the report was found to link vaccinations with rare disorders like Guillain-Barre Syndrome, a concern that prevents some people from getting vaccinations.
Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time?
Martens P, Brownell M, Au W, MacWiliam L, Prior H, Schultz J, Guenette W, Elliott L, Buchan S, Anderson M, Caetano P, Metge C, Santos R, Serwonka K
This deliverable provides information on approximately 15 key indicators of health status, over time and by a measure of socioeconomic status (income quintiles). MCHP researchers looked at the distribution of disease, death and the use of preventive healthcare across income groups in Manitoba to provide useful information for various government reports on the health status of Manitobans in 2010. The research may also assist in laying a foundation for further work on inequities.The Additional Cost of Chronic Disease in Manitoba
Finlayson G, Ekuma O, Yogendran M, Burland E, Forget E
Researchers at the University of Manitoba compared the costs of healthcare for people with arthritis, asthma and chronic obstructive pulmonary disease (COPD), coronary heart disease, diabetes, and stroke over a two-year period. The report compares what it costs the province to provide healthcare to individuals with one of these conditions with individuals who do not have the condition. Spending on average for all Manitobans without one of the chronic condition studied is about $4,000 per person over two years. Spending on Manitobans with a chronic condition is from twice as much for asthma and COPD to six times as much for people who have had a stroke. The report also breaks-down costs by looking at physician services, inpatient and day surgery, hospital care, prescription drugs, home care and nursing homes for each of these conditions. One of the most interesting findings of this research is that the cost of treating chronic disease is different throughout the province. After considering age, sex, and other influencing factors, people who were treated for similar conditions had different costs for healthcare depending upon where they lived. These differences are not caused by the actual cost of providing services because these values have been equalized - they're caused by using services differently. The report includes important information that will be useful for health and social policy makers in the province to determine the potential impact of healthcare costs for programs designed to reduce the incidence of chronic disease.
Composite Measures/Indices of Health and Health System Performance
Metge C, Chateau D, Prior H, Soodeen R, De Coster C, Barre L
While hundreds of indicators exist that measure specific aspects of health, use of health services, and health system performance, there is a lack of high quality composite measures in key strategic areas. For example, within the province of Manitoba there is no single measure that tells us what is happening overall for chronic diseases, waiting times, or patient safety? Indicators at the population/system-wide level would be useful for strategic planning and reporting. This project, constructs composite indicators that compare differences in healthcare delivery and health outcomes across Manitoba's Regional Health Authorities (RHAs) and Winnipeg Community Areas (CAs), and allow planners to track them over time. The findings suggest however, that the effort required to develop, validate, and update composite indices is disproportionate to the value of the information they yield.
What Works? A First Look at Evaluating Manitoba's Regional Health Programs and Policies at the Population Level
Martens P, Fransoo R, The Need to Know Team, Burland E, Prior H, Burchill C, Romphf L, Chateau D, Bailly A, Ouelette C
Decision-makers and planners in Manitoba have access to plenty of research describing the health of the population. What has been missing until now is information that starts to connect the dots between the health of residents and the programs and policies that may be contributing to good health outcomes.
Defining and Validating Chronic Diseases: An Administrative Data Approach
Lix L, Yogendran M, Burchill C, Metge C, McKeen N, Moore D, Bond R
Six out of ten Canadians have a chronic disease, such as high blood pressure, diabetes or asthma.To prevent chronic diseases in Manitoba, we need to know how widespread they are, who is at risk of getting a them, and how disease patterns are changing over time. The tools developed in this report provide some answers.
Sex Differences in Health Status, Health Care Use, and Quality of Care: A Population-Based Analysis for Manitoba's Regional Health Authorities
Fransoo R, Martens P, The Need to Know Team, Burland E, Prior H, Burchill C, Chateau D, Walld R
Very little has been known about the differences between the sexes in Manitoba when it came to health-related issues. This report changes that. It offers Manitobans a fact-based, sex-specific, region-by-region look at health in our province.
Patterns of Regional Mental Illness Disorder Diagnoses and Service Use in Manitoba: A Population-Based Study
Martens PJ, Fransoo R, McKeen N, The Need to Know Team, Burland E, Jebamani L, Burchill C, De Coster C, Ekuma O, Prior H, Chateau D, Robinson R, Metge C
Mental illness can have a devastating effect on people's lives. It also has a staggering impact on Manitoba's use of hospitals, physicians, home care, nursing homes and pharmaceuticals. This report by MCHP offers RHAs a comprehensive look at mental illness and its demands on their health care services.Patterns of Health Care Use and Cost at the End of Life
Menec V, Lix L, Steinbach C, Ekuma O, Sirski M, Dahl M, Soodeen R
This study tries to answer end-of-life questions: Are most people dying in hospital? Are they using a disproportionate share of health care services in their final months? Are the resulting costs threatening to bankrupt our health care system?
Why is the Health Status of Some Manitobans Not Improving? The Widening Gap in the Health Status of Manitobans
Brownell M, Lix L, Ekuma O, Derksen S, Dehaney S, Bond R, Fransoo R, MacWilliam L, Bodnarchuk J
An earlier MCHP report (Roos NP et al. 2001) found that the gap in health between the least and most healthy Manitobans was getting wider; this study investigates the reasons why.
Indicators of Health Status and Health Service Use for the Winnipeg Regional Health Authority
Frohlich N, Fransoo R, Roos NP
This report explores the relationship between health status in the different areas of Winnipeg, and residents use of health care services.The Impact of Influenza-Like Illness on the Winnipeg Health Care System: Is an Early Warning System Possible?
Menec V, Black C, MacWilliam L, Aoki F, Peterson S, Friesen D
The project addresses four questions: (1) What is the impact of influenza on the health of Manitobans and on the health care system? (2) What are the characteristics of patients hospitalized for flu-like illnesses? (3) Are preventive strategies optimal? (4) Is an early warning system possible?Changes in Health and Health Care Use of Manitobans: 1985-1998
Roos NP, Shapiro E, Bond R, Black C, Finlayson G, Newburn-Cook C, MacWilliam L, Steinbach C, Yogendran M, Walld R
Changes in Manitoban's health and the health care system over a fourteen-year period from 1985 to 1998 are reviewed in this report. Areas discussed include health status, use and availability of health services, spending, and the aging of the population.A Look at Home Care in Manitoba
Roos NP, Stranc L, Peterson S, Mitchell L, Bogdanovic B, Shapiro E
This project adds routine provincial records on home care to POPULIS, thus permitting for the first time a description of how home care is used in Manitoba.
Long-stay Patients in Winnipeg Acute Care Hospitals
De Coster C, Kozyrskyj A
This study describes the characteristics associated with long-stay patients in Winnipeg acute care hospitals. Long-stay patients are defined as those staying over 30 days.A Description of the Use of Insured Health Care Services by Income Assistance Recipients in the Province of Manitoba: A Pilot Study. Recipients of Income Assistance for Mental Health Disability
Mustard CA, Derksen S, Kozyrskyj A
The primary purpose of this study was to test the feasibility of using anonymized data from the Ministries of Health and Family Services to understand more about the relationship between poverty and health.
Measuring Morbidity in Populations: Performance of the Johns Hopkins Adjusted Clinical Group (ACG) Case-Mix Adjustment System in Manitoba
Reid RJ, MacWilliam L, Roos NP, Bogdanovic B, Black C
The Johns Hopkins Adjusted Clinical Group system is a new case-mix tool, which uses ambulatory and hospital diagnostic information, in addition to demographics, to measure the burden of illness in a population. This report explores its capabilities using Manitoba administrative data.
Issues in Developing Indicators for Needs-Based Funding
Frohlich N, Carriere KC
Here we focus on the theoretical question of how to distribute resources for a single sector - physician services - in which the data are good but services are not currently distributed according to need.
Patterns of Tonsillectomy in Manitoba 1989-1993
Black C, Peterson S, Mansfield J, Thliveris M
Tonsillectomies were examined for the Clinical Guidelines and Analysis Program (CGAP), a collaborative project of the College of Physicians and Surgeons and MCHP, funded by Manitoba Health.
Socioeconomic Gradients in Mortality and the Use of Health Care Services at Different Stages in the Life Course
Mustard CA, Derksen S, Berthelot J, Wolfson MC, Roos LL, Carriere KC
Statistics Canada and Manitoba Health Research data were linked to create a robust and unique data set that allowed this examination of how our health is affected by socioeconomic status.
Population Health: Health Status Indicators. Volume I: Key Findings
Cohen MM, MacWilliam L Population Health: Health Status Indicators. Volume II: Tables and Figures
Cohen MM, MacWilliam L Socio-Economic Characteristics (Population Health Information System 1991/92 - 1986 Census Version)
Frohlich N, Mustard CA A Report on the Health Status, Socio-Economic Risk and Health Care Use of the Manitoba Population, 1992-93 and Overview of the 1990-91 to 1992-93 Findings
Frohlich N, Markesteyn T, Roos NP, Carriere KC, Black C, De Coster C, Burchill CA, MacWilliam L
POPULIS is a population-based information system developed by MCHP. It provides data on current health and illness profiles, including socio-economic risk factors and patterns of health care use across Manitoba.The Utilization of Medical Services for Mental Health Disorders, Manitoba: 1991 - 1992
Tataryn DJ, Mustard CA, Derksen S
A report on the use of mental health care services in Manitoba. Prevalence estimates of mild and severe mental health problems across regions and their relationship to socio-economic status are also examined.
Manitoba Health Care Studies and their Policy Implications (Report #91-04-01)
Manitoba Centre for Health Policy
Community Health Sciences, Max Rady College of Medicine,
Rady Faculty of Health Sciences,
Room 408-727 McDermot Ave.
University of Manitoba
Winnipeg, MB R3E 3P5 Canada