Deliverables: Social Determinants

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2021

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Gastrointestinal Endoscopy (GIE) Utilization in Manitoba
Lix LM, Singh H, Derksen S, Sirski M, McCulloch S

Gastrointestinal endoscopy (GIE) procedures are used to examine a person’s digestive tract. They are common procedures; more than 1 in 4 Manitobans will have a GIE procedure in a 10-year period. They are used to learn about the causes of symptoms, such as stomach pain or diarrhea, to diagnosis conditions of the digestive tract such as inflammatory bowel disease, and to screen people who are at risk for some cancers such as colorectal cancer. In this study, we looked at changes in procedure rates across health regions and population groups, described wait times in the Winnipeg and Southern Health-Santé Sud regions, and described outcomes after a GIE procedure, such as emergency department use and complications. We found an increase in procedure rates over time that was greatest in those 50 years and older. Wait times for GIE procedures were similar for urgent procedures in both health regions, but less similar for non-urgent procedures. Adverse outcomes are rare, but because many GIE procedures are performed each year, a large number of people can still be affected. Standardized tools and methods to collect and report on wait times and reasons for having a GIE procedure can help to reduce variations in rates and outcomes for Manitobans.

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Using Administrative Data to Predict Near-Future Critical Illness
Garland A, Chateau D, Marrie RA, Wunsch H, Yogendran M, Soodeen RA

Critically ill people are cared for in hospital intensive care units. Many die in hospital, and many who survive experience long-term problems. If we could identify people at high risk of developing critical illness before it occurs, we might be able to delay or prevent it from happening, allowing them to remain healthy in the community. This study aimed to identify adult Manitobans with a high probability of developing critical illness in the near future. The research team applied advanced statistical methods to the data in the Manitoba Population Research Data Repository at the Manitoba Centre for Health Policy. The results showed that instead of the stated goal of identifying people with at least a 1 in 3 chance of developing critical illness, the team was only able to identify people with at least a 1 in 20 chance. However, additional study may be warranted to assess the value of alerting primary care providers to such individuals on their patient rosters. Also, the finding that frail people are much more likely to develop critical illness suggests that it might be valuable to have physicians routinely measure frailty in the people they care for.

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2020

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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.

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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).

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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.

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The Overlap Between the Child Welfare and Youth Criminal Justice Systems: Documenting "Cross-Over Kids" in Manitoba
Brownell M, Nickel N, Turnbull L, Au W, Ekuma O, MacWilliam L, McCulloch S, Valdivia J, Boram Lee J, Wall-Wieler E, Enns J

This study investigated the relationship between the child welfare and the youth criminal justice systems. It included analyses of characteristics of children and youth involved in both systems, such as mental disorders, developmental disabilities, and school achievement. The main objectives of the project were to: 1). Quantify the overlap between involvement with the child welfare system and the youth criminal justice system; and 2). Identify the characteristics associated with involvement in both systems. For most analyses a 1994 birth cohort was followed to describe child welfare system involvement, youth justice system involvement, and health and social outcomes into young adulthood. Recognizing the over-representation of Indigenous children and youth in both systems, the report provides context on a description of that over-representation.

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Updates and Errata (PDF)
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2019

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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.

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Updates and Errata (PDF)
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2017

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Describing Patient Populations for the My Health Team Initiative
Chateau D, Katz A, Metge C, Taylor C, McDougall C, McCulloch S

The province of Manitoba is in the process of restructuring primary care through the development of My Health Teams, which are networks consisting of primary care providers (physicians and nurse practitioners) and other professionals from health or related disciplines (e.g., dieticians, mental health counsellors, social workers). This study describes the patient populations that current or future My Health Teams could expect to provide care to. We examined where patients access primary care in relation to where they live in order to provide a more accurate description of patient populations. We also examined if patients were high users of services, medically complex, or socially complex. The last category addresses the social determinants of health and this is the first study to apply these social complexity indicators across the province. In addition, we examined the overlap between these three types of patients to determine how distinct patients with social complexities and medical complexities were, and whether these patients were also high user of services.

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Updates and Errata (PDF)
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2016

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A Comparison of Models of Primary Care Delivery in Winnipeg
Katz A, Valdivia J, Chateau D, Taylor C, Walld R, McCulloch S, Becker C, Ginter J

This deliverable compares the five models of primary care delivery that exist in Winnipeg: non-PIN FFS, PIN FFS, WRHA Primary Care, Community Health, and family medicine teaching clinics. The main objectives of this project are as follows: 1. Compare/evaluate quality of care indicators for the five models of primary care delivery 2. Discuss the impact of patient social complexity on service provider, quality of care and roster/ panel size Of particular interest is the development of social complexity indicators in this deliverable. Social complexities include patient characteristics such as living in social housing, involvement with the justice system, and having a major mental health diagnosis.

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2013

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Social Housing in Manitoba. Part I: Manitoba Social Housing Data
Finlayson G, Smith M, Burchill C, Towns D, Peeler W, Soodeen RA, Prior H, Huq S, Guenette W

Part I of this report describes bringing in the Tenant Management System (TMS) data for the period 1995/96-2009/10) and integrating it into the Repository at MCHP. Tests were conducted to determine the amount of data which were missing, inconsistent, or out of range.

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Social Housing in Manitoba. Part II: Social Housing and Health in Manitoba: A First Look
Smith M, Finlayson G, Martens P, Dunn J, Prior H, Taylor C, Soodeen RA, Burchill C, Guenette W, Hinds A

This "first look" at the health status and health care use of residents of Social Housing highlights some of the disparities they experience relative to other Manitobans. A selection of health care use, physical health, mental health and educational achievement indicators, with a particular focus on child and youth issues, chosen for their potential relevance to program and policy development are presented. Despite wide differences in health status, there are encouraging similarities for some health screening and preventative care measures.

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2010

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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.

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Summary (PDF)
Updates and Errata (PDF)
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2009

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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.

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2004

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How Do Educational Outcomes Vary With Socioeconomic Status? Key Findings from the Manitoba Child Health Atlas 2004
Brownell M, Roos NP, Fransoo R, Guevremont A, MacWilliam L, Derksen S, Dik N, Bogdanovic B, Sirski M

The poorer their neighbourhood, the more likely children are to have difficulties in school, fail standards tests, fail a grade, quit school and have shorter lives. And when do these kids start falling behind? high school? elementary school? grade one? What are the implications? What can be done to change this trend?

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2003

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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.

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2000

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Considering the Health Care Needs of Children Living in Households Receiving Income Assistance in Manitoba: Family Services and Manitoba Health Pilot Project
Kozyrskyj A, Mustard CA, Derksen S

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.

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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.

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1995

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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.

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1994

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Socio-Economic Characteristics (Population Health Information System 1991/92 - 1986 Census Version)
Frohlich N, Mustard CA

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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.

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1991

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Units of Observation and Measures of Socio-Economic Status (Manitoba Population Health Project)
Mustard CA

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