Canadian Community

Health Survey

Larry MacNabbCCHS Dissemination Manager

Yves BélandCCHS 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

NPHS Household

Longitudinal & X-sectional(Provinces)

NPHS North

Longitudinal & X-sectional(Territories)

NPHS Institutions

Longitudinal & X-sectional (-C3)(Provincial Health Institutions)

HEALTH SURVEYS

1994-1999

Health InformationRoadmap 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

NPHS Household

Longitudinal & X-sectional(Provinces)

NPHS North

Longitudinal & X-sectional(Territories)

NPHS Institutions

Longitudinal & X-sectional (-C3)(Provincial Health Institutions)

HEALTH SURVEYS

NPHS Household

Longitudinal(Provinces)

NPHS North

Longitudinal(Territories)

NPHS Institutions

Longitudinal(Prov. Hlth Institutions)

CCHS

Cross-sectional(Provinces + Territories)

H E ALTH S U RV E YS

1994-1999

Since 2000

Population Health Surveys

NPHS CCHS Longitudinal Cross sectional

National and National, provincial, territories

provincial levels & health regions levels

One respondent One or two respondents per household per household

Core, focus, buy-in Health region selection of

and supplements optional health modules

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• 130,000 respondents

• stratified by health region

• Questionnaire content

– common content

– optional content selected by health regions

• Estimates for health regions, provinces and Canada

Year 2• 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)

Prov. #HRs n Prov. #HRs n_

NF 6 3,870 SK 11 8,009PE 2 3,651 AB 17 14,456NS 6 5,319 BC 20 18,302NB 7 4,996 YT 1 809QC 16 22,667 NT 1 1,001ON 37 39,278 NU1 707MB 11 8,470

sample size (n) = 131,535CANADA 136

Health Region Sample

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

TopicHealth

Regions TopicHealth

RegionsDepression 134 Dental visits 56Driving under influence

103 Mastery 55

Changes made to improve health

100 Breast examinations 53

Work stress 97 Self-esteem 45Social support 86 Home care 41Suicidal thoughts and attempts

70 Drug use 29

Breast self-examinations

69 Distress 24

Sedentary activities 68 Mood 14Use of protective equipment

59 Spirituality 8

Sexual behaviours 57 Physical check-up 4Smoking cessation aids

56 Eye exams 2

Cycle 1.1- Optional ContentProportion of Total Sample Asked Optional Module, Canada, Provinces and TerritoriesCanadian Community Health Survey, 2000/01

Module Canada NF PE NS NB PQ ON MB SK AB BC YK NT NUBreast 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% - - - 100%Depression 99% 100% 100% 100% 100% 100% 98% 100% 95% 100% 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% - - - - 100%Home care 35% - 100% 100% 100% 100% 19% - - - - 100% 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% 100%Sexual behaviours 44% - 100% - - - 98% - - 100% - 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% 100%Spirituality 5% - - - - - - - 56% - - 100% - 100%Suicidal thoughts and attempts 53% - - 100% 100% 100% 28% 100% - 100% - 100% 100% 100%Use of protective equipment 44% - - - - - 100% - 52% 100% - - - -Work stress 76% - 100% 100% - 100% 100% 100% 79% 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

Master

Microdata

RecordsVariables

SharePUMF

Share File Production

Master File• Maintained by Statistics

Canada

• Record for every respondent

ID Link Share

A Y Y

B Y N

C N Y

D N N

Share File• Ministries of

Health/Share partners

• Only respondents who agree to share

ID LinkShare

A Y Y

C N Y

Share File contains no identifiable information

•Name

•Address

•Date of Birth

•Health Care number

Public Use Microdata File

Master File

ID Link Share

A Y Y

B Y N

C N Y

D N N

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

Microdata Release

Committee

•Group of Statistics Canada

experts on maintaining respondent

confidentiality

Data Linkage

Master & Link FileID Link Share

HC#

A Y Y Y1

B Y N Y2

C N Y N

D N N N

Share FileID Link Share

A Y Y

C N Y

Link ID File• By Request Only

• Healthcard# and linkage info

• Random ID links to share

ID Link Share HC#

A Y Y Y1

Administrative Date

HC# Name Add

Y1 Joe123

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 GuidelinesAcceptable 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 Look-up 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 confusionCycle number Alph.1.1 1 A1.2 2 B2.1 3 C etc.

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

Cansim IICansim IIData Warehouse$ for Download

Canadian StatisticsCanadian StatisticsFree

Canada Level Detail

Health IndicatorsHealth IndicatorsFree

Detailed Health Region Information

Health RegionHealth RegionProfilesProfiles

FreeSimple

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 self-

perceived 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 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

Cycle 1.2 (In the field) 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

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 + commoncore repeated

30,000 May – Dec. 2002

2.1 Common core + Optional modulesexpanded

130,000 Jan. – Dec. 2003

2.2 Nutrition, dietary recall, psychosocialdeterminants, fruit and vegetableconsumption, food insecurity + commoncorePotential supplement for physicalmeasures

30,000 Jan –Dec. 2004

3.1 Common core + Optional modulesexpanded

130,000 Jan. – Dec. 2005

3.2 ???? 30,000 Jan. – Dec. 2006

CCHS DescriptionCCHS Description

WEB SITE

NPHS and CCHS Questionnaires and documentation are available on our web site at:

www.statcan.ca/health_surveys