Transcript Canadian Community Health Survey

Canadian
Community
Health
Survey
Larry MacNabb
CCHS Dissemination Manager
Yves Béland
CCHS Senior Methodologist
Part 1
Health Survey Program Overview
Objectives
• Aid in the development of public policy;
• Understand the determinants of health;
• Collect data on the economic, social,
demographic, occupational and
environmental correlates of health;
Objectives
• Increase the understanding of the
relationship between health status and
health care utilization;
• Follow a panel of people to reflect the
dynamic processes of health;
• Provide a means to supplement content or
sample;
Health Surveys Program
1994-1999
HEALTH SURVEYS
NPHS Household
NPHS North
NPHS Institutions
Longitudinal & X-sectional
(Provinces)
Longitudinal & X-sectional
(Territories)
Longitudinal & X-sectional (-C3)
(Provincial Health Institutions)
Health Information
Roadmap Initiative
• Collaboration between Canadian Institute
for Health Information (CIHI), Statistics
Canada & Health Canada
• Answer two basic questions:
– How healthy is Canada’s health care
system?
– How healthy are Canadians?
• Canadian Community Health Survey
(CCHS)
CCHS Objectives
• Provide timely, consistent, cross-sectional
estimates of health determinants, health status and
health system utilization across Canada
• Sub-provincial levels of geography (136 Health
Regions)
• Flexible survey instrument
– meet specific health region data gaps
– develop focused survey content for key data gaps
– quick response to emerging issues
Health Surveys Program
1994-1999
HEALTH SURVEYS
NPHS Household
NPHS North
NPHS Institutions
Longitudinal & X-sectional
(Provinces)
Longitudinal & X-sectional
(Territories)
Longitudinal & X-sectional (-C3)
(Provincial Health Institutions)
Since 2000
HEALTH SURVEYS

NPHS Household
NPHS North
NPHS Institutions
CCHS
Longitudinal
(Provinces)
Longitudinal
(Territories)
Longitudinal
(Prov. Hlth Institutions)
Cross-sectional
(Provinces + Territories)
Population Health Surveys
NPHS
Longitudinal

National and

provincial levels
One respondent
household
Core, focus, buy-in
and supplements
CCHS
Cross sectional
National, provincial, territories
& health regions levels

One or two respondents
per household

Health region selection of
optional health modules
per
Part 2
CCHS Overview
&
Content Summary
CCHS Consultation Partners
• Consultations with stakeholders about the content is
another component of the CCHS that makes this health
survey so unique and different from the NPHS.
• Stakeholders include:
– Regional, Provincial, & Federal health agencies
– CIHI (Canadian Institute for Health Information)
– other Health researchers
– Advisory committee
1999 Consultations
17 workshops, 225+ participants
Topic rankings
Final Report
common and optional content
target youth and seniors
smaller health regions
in-depth examination of issues
CCHS Survey Design
Year 1
Year 2
• 130,000 respondents
• stratified by health region
• Questionnaire content
– common content
– optional content selected by
health regions
• Estimates for health regions,
provinces and Canada
• 30,000 respondents
• stratified by province
• Questionnaire content
– focus content
– additional general content
– 60+ minutes
• Estimates for provinces and
Canada
CCHS Content 1.1
Cycle 1.1 Questionnaire (45 min.):
 Common Content (30 minutes):
 Priority topics
 for all Health Regions
 Optional Content (10 minutes):
 specific modules selected by individual Health
Regions
 Standard Socio-demographic content
(5 minutes)
Health Region Sample
Prov. #HRs
NF
PE
NS
NB
QC
ON
MB
6
2
6
7
16
37
11
n
3,870
3,651
5,319
4,996
22,667
39,278
8,470
Prov.
SK
AB
BC
YT
NT
NU
CANADA 136
#HRs
11
17
20
1
1
1
sample size (n) = 131,535
n_
8,009
14,456
18,302
809
1,001
707
CCHS Health Regions - 2001
Health Regions
Cycle 1.1 - Common Content
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Alcohol
Alcohol dependence / abuse
Blood pressure check
Breastfeeding
Chronic condition
Contacts with mental health
professionals
Exposure to second hand smoke
Flu shots*
Food insecurity
Fruit & vegetable consumption
General health
Health care utilization
Health Utility Index (HUI)
Height / Weight
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Injuries
Mammography
PAP smear test
Patient Satisfaction**
Physical activities
PSA test
Restriction of activities
Smoking
Tobacco alternatives
Two-week disability
Household composition & housing
Income
Labour force
Socio-demographic characteristics
Administration
Cycle 1.1 Optional Content
•
•
•
•
•
•
•
•
•
•
•
•
•
Breast examinations
Breast self examinations
Changes made to improve health
Child & adult stressors (traumas)
Dental visits
Depression
Distress
Driving under influence
Drug use
Eye examinations
Home care
Mastery
Mood
•
•
•
•
•
•
•
•
•
•
•
•
Ongoing problems
Physical check-up
Recent life events
Sedentary activities
Self-esteem
Sexual behaviours
Smoking cessation aids
Social support
Spirituality
Suicidal thoughts and attempts
Use of protective equipment
Work stress
Optional Content Selection
Topic
Depression
Driving under
influence
Changes made to
improve health
Work stress
Social support
Suicidal thoughts
and attempts
Breast selfexaminations
Sedentary activities
Use of protective
equipment
Sexual behaviours
Smoking cessation
aids
Health
Regions
134
103
100
Topic
Dental visits
Mastery
Health
Regions
56
55
Breast examinations
53
97
86
70
Self-esteem
Home care
Drug use
45
41
29
69
Distress
24
68
59
Mood
Spirituality
14
8
57
56
Physical check-up
Eye exams
4
2
Cycle 1.1- Optional Content
Proportion of Total Sample Asked Optional Module, Canada, Provinces and Territories
Canadian Community Health Survey, 2000/01
Module
Canada NF
PE
NS
NB
PQ
ON
MB SK AB
BC
YK
NT
Breast examinations
39%
100%
100%
100%
32%
Breast self-examinations
50%
100%
100%
94%
62% 100%
100%
Changes made to improve health
71%
100% 100%
100%
100%
94% 100% 100% 100%
Dental visits
42%
100%
8% 100%
Depression
99%
100% 100% 100% 100% 100% 98% 100% 95% 100% 100% 100% 100%
Distress
21%
100%
100%
16%
Driving under influence
82%
100% 100%
100% 100%
54% 100% 100%
Drug use
24%
79%
Eye exams
1%
17%
Flu shots
43%
100% 100%
100%
100%
48%
Home care
35%
100% 100% 100% 100% 19%
100% 100%
Mastery
36%
100% 100%
19% 100% 18%
100% 100% 100%
Mood
8%
100% 23%
Physical check-up
2%
31%
Sedentary activities
55%
100% 100% 79% 100% 55%
100%
Self-esteem
27%
100%
100% 43%
100%
100%
Sexual behaviours
44%
100%
98%
- 100%
100%
Smoking cessation aids
43%
100% 100% 100%
100%
32%
100%
Social support
63%
100% 100% 100% 100% 100% 2%
75% 100% 100% 100% 100%
Spirituality
5%
56%
100%
Suicidal thoughts and attempts
53%
100% 100% 100% 28% 100% - 100%
100% 100%
Use of protective equipment
44%
100%
52% 100%
Work stress
76%
100% 100%
100% 100% 100% 79% 100%
-
NU
100%
100%
100%
100%
100%
100%
100%
100%
100%
-
Part 3
Outputs
•Microdata
•Tabular Statistics
•Analytical Products
•Client Support
Microdata
• Master File
– Statistics Canada
– Research Data Centers
– Remote Access
• Share File
– Health Canada
– Provincial/Territorial Ministries of health
– Health Regions (3rd Party Sharing)
• Public Use Microdata File
– Free 136 Health Regions & sharing partners
Microdata
Variables
Records
Share
PUMF
Master
Share File Production
Master File
Share File
• Maintained by Statistics contains no
Canada
identifiable
• Record for every
information
respondent
ID
A
B
C
D
Link
Y
Y
N
N
•Name
Share
Y
N
Y
N
•Address
•Date of Birth
•Health Care
number
Share File
• Ministries of
Health/Share partners
• Only respondents who
agree to share
ID
A
C
Link
Y
N
Share
Y
Y
Public Use Microdata File
Master File
ID
A
B
C
D
Link
Y
Y
N
N
Share
Y
N
Y
N
Microdata
Release
Committee
•Group of
Statistics Canada
experts on
maintaining
respondent
confidentiality
PUMF
•
•
•
•
Available to public
Aggregated data
Geography (<70 k)
Age groups vs. single year
of age
• Other aggr/suppr
ID
Link
Share
A
Y
Y
B
Y
N
C
N
Y
D
N
N
Data Linkage
Master & Link File
ID
A
B
C
D
Link
Y
Y
N
N
Share
Y
N
Y
N
HC#
Y1
Y2
N
N
Link ID File
• By Request Only
• Healthcard# and linkage info
• Random ID links to share
ID
Link
Share
HC#
A
Y
Y
Y1
Share File
ID
A
C
Link
Y
N
Share
Y
Y
Administrative
Date
HC#
Y1
Name
Joe
Add
123
Sharing Agreement Statistics Canada
- Ministry of Health
• Statistics Canada will share individual
survey responses collected for the Canadian
Community Health Survey with the
Ministry of Health
– Only responses for individuals agreeing to
share their information will be provided
Usage of Shared Data
• Only statistical aggregates may be
published
• Respondent information can not be linked
to administrative health records without
consent to do so from a survey respondent
Usage Continued
• Information can not be released before the
official release by Statistics Canada
• Aggregates released must not identify a
person, business or organization directly or
indirectly
Confidentiality of Data
• Shared information is to be treated as
confidential and must be protected
Third Party Sharing
• Ministry can share with health regions
individual survey responses without any
names, addresses or identifying numbers if
– Written agreement between Ministry of Health and
Health Region
– Health Region can maintain same level of security and
protection as required of the Ministry of Health
including any Provincial requirements
Microdata Files
• Fixed Record ASCII share file (text)
• File input statement/record layout (SAS,
SPSS)
• Variable Format (SAS, SPSS)
• Variable Value Format (SAS, SPSS)
• Bootstrap Weights
• Bootstrap Programs
Microdata Documentation
•
•
•
•
•
•
•
Background
Objectives
Content
Sample Design
Data Collection
Processing
Data Quality
• Tabulation Guidelines
• Approx. Sampling
Variability Tables
• Weighting
• File Usage
Microdata Documentation
Appendices
•
•
•
•
•
Questionnaire
Record Layout
Data Dictionary
CV Tables
Derived Variable Specifications
Tabulation Guidelines
Type of estimate
CV
Guidelines
Acceptable
0.0-16.5
Unrestricted release
Marginal
16.6-33.3
Unrestricted release but
with warning cautioning
users of the high
sampling variability
(Identified by E).
Unacceptable
> 33.3
No release
(Flagged with F).
Tabulation Guidelines (CV Lookup Estimates)
Must ensure users do not infer greater accuracy than
possible with approximate variances:
Estimates in main body of a table rounded to nearest
100;
Subtotals and totals derived from unrounded data and
then rounded to nearest 100;
Averages, proportions and rates derived from
unrounded and then rounded to 1 decimal place;
Cells based on < 30 respondents should be
suppressed
Approximate CV reported
Tabulation Guidelines (Bootstrap
Variance Estimation)
Exact estimate of variance
Unrounded estimates in main body of a table;
Unrounded subtotals and totals;
Averages, proportions and rates should be derived
from unrounded and then rounded to 1 decimal place;
Cells based on <10 respondents should be suppressed
CV should be reported
CCHS Variable Naming
Convention
 Variable names are created from information re: type of
data
 Example: Qu. 8B, Depression Module, cycle 1.1
(DP_Q08B)
8 characters in length
Ex.: DPSA_08B
 1-3 module/section name DPS (depression)
 4 survey cycle
A (cycle 1.1)
 5 variable type
_ (underscore=coll.
data)
 6-8 question number
08B
CCHS Variable Naming
Convention
Position 1, 2 & 3: Section Name
CCC: Chronic Conditions
INC:
Income
LBF:
Labour Force
PAC: Physical Activities
SMK: Smoking
SXB: Sexual Behaviour
etc.
CCHS Variable Naming
Convention
Position 4: Survey Number
 only one digit
 use of alphabetical symbols rather than
numbers to limit confusion
Cycle 
1.1
1.2
2.1
etc.
number
1
2
3

Alph.
A
B
C
CCHS Variable Naming
Convention
Position 5: Variable Type
_: collected variable
D: derived variable
F: flagged variable
G: grouped variable
CCHS Variable Naming
Convention
Position 6-8:
questionnaire number / variable name
 corresponds to the question number in
questionnaire
ex.: Q03  03; Q02  02
 ordered options use a letter to represent
the corresponding options
ex.: Q15, 1st option  15A
Q15, 3rd option  15C
Master File Data Access
Remote Access
 Submission by email
 Master dummy files
  1000 emails/year with  1.5
program/email
On-site Access (ROs, RDCs)
 Deemed employee of STC
 20 active research teams in Ros; 16 in
RDCs
Custom tabulations (cost recovery)
Organization of Electronic Data
Health Region
Profiles
Canadian Statistics
Free
Canada Level Detail
Free
Simple
Cansim II
Data Warehouse
$ for Download
Health Indicators
Free
Detailed Health Region
Information
Tabular Statistics
• CANSIM II main dissemination vehicle
– minimum one table for every CCHS questionnaire
module
– Counts and confidence intervals
– Province, Health Region, Age and Sex
• Canadian Statistics
• Corporate Community Profiles
• ePubs such as Health Indicators
Analytical Products
• Health Reports 13.3 - March release
• Based on data received during first six
months of collection
• National level results focusing on new
CCHS content
– Effect of sense of community belonging on selfperceived health status
– Socio-demographic factors affecting winter fruit and
vegetable consumption
– Unmet health care needs
Analytical Products
• Daily - May 8, 2002
• Data Officially Released
• Analysis focusing on
– Obesity
– Physical Activity
– Unmet health care needs
Other Analytical Products
• Joint Statistics Canada & CIHI Publications
– How Healthy are Canadians?
– Health Care in Canada
Client Support
• Health Statistics Division & Advisory
Services Division client services through
head and regional offices
• Regular updates and enhancements to
CCHS website
• Customisable workshops covering all
aspects of the CCHS
– Content, Sample Design, Weighting, Data
Quality, Release Guidelines, Bootstrap Variance
Estimation
Future CCHS Cycles
Cycle 1.1
Cycle 1.2 (In the field)








General content
130 000 sample
Health region estimates
Spring 2002 release
Cycle 2.1 (Final
Planning)




General content
130 000 sample
Health region estimates
Summer 2004 release
Focus content (mental health)
30 000 sample
provincial estimates
Fall 2003 release
Cycle 2.2 (Proposed)




Focus content (nutrition)
30 000 sample
provincial estimates
Fall 2005 release
CCHS Description
Cycle/
Component
Content
Sample
Collection
1.1
27 Common core + 23 Optional modules
130,000
Sept. 00 - Oct. 01
1.2
Mental disorders, well-being + common
core repeated
30,000
May – Dec. 2002
2.1
Common core + Optional modules
expanded
130,000
Jan. – Dec. 2003
2.2
Nutrition, dietary recall, psychosocial
determinants, fruit and vegetable
consumption, food insecurity + common
core
Potential supplement for physical
measures
30,000
Jan –Dec. 2004
3.1
Common core + Optional modules
expanded
130,000
Jan. – Dec. 2005
3.2
????
30,000
Jan. – Dec. 2006
WEB SITE
NPHS and CCHS Questionnaires and
documentation are available on our web site
at:
www.statcan.ca/health_surveys