Tu JV, Pinfold SP, McColgan P, Laupacis A, editors' Access to Health Services in Ontario: ICES Atlas

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(No Transcript)
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Sources

• Tu JV, Pinfold SP, McColgan P, Laupacis A,
  editors. Access to Health Services in Ontario
  ICES Atlas. 2nd Edition. Toronto Institute for
  Clinical Evaluative Sciences 2006.
• Tu JV, Pinfold SP, McColgan P, Laupacis A,
  editors. Access to Health Services in Ontario
  ICES Atlas. Toronto Institute for Clinical
  Evaluative Sciences 2005.

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Table of Contents
Slides

• Background ..........................
  ..4-5
• Five Key Health Services
• Cancer Surgeries
• Methodology ........................7
• Key Findings Ontario and LHIN .9-38
• Cardiac Procedures
• Methodology ..................... 40
• Key Findings Ontario and LHIN .. 42-64
• Cataract Surgery
• Methodology .66
• Key Findings Ontario and LHIN....67-78
• Total Hip and Knee Replacement
• Methodology..80
• Key Findings Ontario and LHIN.81-95
• CT and MRI Scanning
• Methodology..97
• Key Findings Ontario and LHIN..98-119
• Interpretative Cautions .120

4
BackgroundAccess to Health Services

• Reducing wait times for surgery and other health
  services is a priority for governments in most
  developed countries.
• In November 2004, the Ontario government launched
  its Wait Time Strategy, which focuses on
  improving access to the following five key health
  services
• selected cancer surgeries (large bowel resection,
  mastectomy, radical prostatectomy and
  hysterectomy)
• selected cardiac procedures (coronary
  angiography percutaneous coronary intervention
  or PCI, also known as angioplasty and coronary
  artery bypass graft surgery or CABG)
• cataract surgery
• total hip and knee replacement
• computerized tomography (CT) and magnetic
  resonance imaging (MRI) scans

5
Background (contd)Access to Health Services

• In the absence of other data sources, ICES
  previously calculated wait times from 2002/03 to
  2004/05 using population-based administrative
  data.
• In 2005, however, hospitals began collecting and
  submitting wait time informationwith the
  exception of cancer and cardiac datato the Wait
  Time Information Office (WTIO).
• As such, only the procedure rates have been
  updated for 2005/06 and 2006/07. Wait time
  information from July 2005 to the present can be
  accessed at www.ontariowaittimes.com

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MethodologyCancer Surgeries

• The number of cancer surgeries performed in
  Ontario was obtained using data from the Canadian
  Institute for Health Informations Discharge
  Abstract Database (CIHI-DAD) and the National
  Ambulatory Care Reporting System (CIHI-NACRS) for
  fiscal years (i.e., April 1 to March 31) 2002/03
  to 2006/07 for Ontarians 40 years of age and
  older.
• Includes abandoned (i.e., not fully completed)
  surgeries.
• Procedure counts were limited to one specific
  procedure per patient per day in instances where
  a patient had more than one cancer procedure.
• Exclusions
• Non-Ontario residents, persons less than 40 years
  of age, procedures performed out of hospital
• Records with missing/invalid age, sex, or LHIN

8
Methodology (contd)Cancer Surgeries

• Census population estimates were used for each of
  the years studied.
• Population estimates by income quintile were
  projected using the income distribution for
  Ontario from the 2001 Census of Canada and
  applying it to the census population estimates
  for each of the years under study.
• The Ontario 2001 census population was used to
  standardize surgical rates.

9
Key FindingsCancer Surgeries

• Volumes
• Ontario (2002/03 to 2006/07)
• The annual number of large bowel resections
  performed in Ontario increased by 5
  (approximately 6,000 large bowel resections to
  6,300 large bowel resections).
• The annual number of mastectomies performed in
  Ontario increased by 7 (approximately 2,700
  mastectomies to 2,900 mastectomies).
• The annual number of radical prostatectomies
  performed in Ontario increased by 30
  (approximately 2,600 radical prostatectomies to
  3,400 radical prostatectomies).
• The annual number of hysterectomies performed in
  Ontario increased by 11 (approximately 1,800 to
  2,000 hysterectomies).

10
Annual number of large bowel resections for
cancer for Ontarians aged 40 years and older,
2002/032006/07
11
Annual number of mastectomies for cancer for
Ontarian women aged 40 years and older,
2002/032006/07
12
Annual number of radical prostatectomies for
cancer for Ontarian men aged 40 years and older,
2002/032006/07
13
Annual number of hysterectomies for cancer for
Ontarian women aged 40 years and older,
2002/032006/07
14
Key Findings (contd)Cancer Surgeries

• Rates (2002/03-2006/07)
• Ontario
• Between 2002/03 and 2006/07, the overall
  age-adjusted rate of hysterectomy remained
  relatively stable, increasing by 2 radical
  prostatectomy rates increased by 19. Overall
  age- and sex-adjusted rates for mastectomy and
  large bowel resection remained relatively stable,
  decreasing by 2 and 4, respectively.
• Age-specific rates for hysterectomy and radical
  prostatectomy peaked among patients 65-74 years
  of age. Age-specific rates for mastectomy and
  large bowel resection were highest among patients
  75-84 years of age. For large bowel resection,
  overall and age-specific rates were higher in
  men, likely reflecting higher colorectal cancer
  incidence in men compared to women.

15
Rate of large bowel resection for cancer per
100,000 Ontarians aged 40 years and older, by sex
and age group, 2002/032006/07
16
Rate of mastectomy for cancer per 100,000
Ontarian women aged 40 years and older, by age
group, 2002/032006/07
17
Rate of radical prostatectomy for cancer per
100,000 Ontarian men aged 40 years and older, by
age group, 2002/032006/07
18
Rate of hysterectomy for cancer per 100,000
Ontarian women aged 40 years and older, by age
group, 2002/032006/07
19
Key Findings (contd)Cancer Surgeries

• Rates (2002/03-2006/07)
• Ontario
• Cancer surgery rates were generally higher among
  individuals living in the wealthiest
  neighbourhoods (income quintile Q5) compared to
  individuals living in the poorest neighbourhoods
  (income quintile Q1). The disparity in rates
  between individuals living in the poorest and
  wealthiest neighbourhoods was largest for radical
  prostatectomy and smallest for large bowel
  resection.
• The disparity in rates may be a reflection of
  potential differences in cancer incidence as well
  as differences in cancer screening (e.g.,
  prostate specific antigen (PSA) screening for
  prostate cancer) among socioeconomic groups.

20
Age- and sex-adjusted rate of large bowel
resection for cancer per 100,000 Ontarians aged
40 years and older, by neighbourhood income
quintile, 2002/032006/07
21
Age-adjusted rate of mastectomy for cancer per
100,000 Ontarian women aged 40 years and
older, by neighbourhood income quintile,
2002/032006/07
22
Age-adjusted rate of radical prostatectomy for
cancer per 100,000 Ontarian men aged 40 years and
older, by neighbourhood income quintile,
2002/032006/07
23
Age-adjusted rate of hysterectomy for cancer per
100,000 Ontarian women aged 40 years and
older, by neighbourhood income quintile,
2002/032006/07
24
Key Findings (contd)Cancer Surgeries

• Rates (2006/07)
• Local Health Integration Networks (LHINs)
• Age- and sex-adjusted cancer surgery rates across
  the LHINs varied by type of surgery. For example,
  surgical rates varied
• 1.4 times for large bowel resection
• more than 2-fold for mastectomy
• approximately 3-fold for radical prostatectomy
  and
• approximately 2-fold for hysterectomy

25
Age- and sex-adjusted rate of large bowel
resection for cancer per 100,000 Ontarians aged
40 years and older, 2006/07
By Local Health Integration Network (LHIN) in
Ontario
26
Age-adjusted rate of mastectomy for cancer per
100,000 Ontarian women aged 40 years and older,
2006/07
By Local Health Integration Network (LHIN) in
Ontario
27
Age-adjusted rate of radical prostatectomy for
cancer per 100,000 Ontarian men aged 40 years and
older, 2006/07
By Local Health Integration Network (LHIN) in
Ontario
28
Age-adjusted rate of hysterectomy for cancer per
100,000 Ontarian women aged 40 years and older,
2006/07
By Local Health Integration Network (LHIN) in
Ontario
29
Key Findings (contd)Cancer Surgeries

• Rates (2006/07)
• Local Health Integration Networks (LHINs)
• Age-specific rates of hysterectomy, mastectomy
  and radical prostatectomy were generally similar
  to those seen at the provincial level. Although
  large bowel resection rates were higher in men
  (as was observed at the provincial level), the
  age-specific rates for large bowel resection
  throughout the LHINs were not consistently
  highest among individuals 75-84 years of age and
  were highest instead, among individuals 85 years
  of age and older.

30
Rate of large bowel resection for cancer per
100,000 Ontarians aged 40 years and older, by sex
and age group, 2006/07 LHIN 1 (Erie St. Clair)
vs. Ontario
31
Rate of mastectomy for cancer per 100,000
Ontarian women aged 40 years and older, by age
group, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario
32
Rate of radical prostatectomy for cancer per
100,000 Ontarian men aged 40 years and older, by
age group, 2006/07 LHIN 1 (Erie St. Clair) vs.
Ontario
33
Rate of hysterectomy for cancer per 100,000
Ontarian women aged 40 years and older, by age
group, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario
34
Key Findings (contd)Cancer Surgeries

• Rates (2006/07)
• Local Health Integration Networks (LHINs)
• Although some variation was observed throughout
  the LHINs, cancer surgery rates were generally
  lower for individuals living in the poorest
  neighbourhoods (income quintile Q1) compared to
  those living in the wealthiest neighbourhoods
  (income quintile Q5).

35
Age- and sex-adjusted rate of large bowel
resection for cancer per 100,000 Ontarians aged
40 years and older, by neighbourhood income
quintile, 2006/07 LHIN 1 (Erie St. Clair) vs.
Ontario
36
Age-adjusted rate of mastectomy for cancer per
100,000 Ontarian women aged 40 years and
older, by neighbourhood income quintile,
2006/07 LHIN 1 (Erie St. Clair) vs. Ontario
37
Age-adjusted rate of radical prostatectomy for
cancer per 100,000 Ontarian men aged 40 years and
older, by neighbourhood income quintile,
2006/07 LHIN 1 (Erie St. Clair) vs. Ontario
38
Age-adjusted rate of hysterectomy for cancer per
100,000 Ontarian women aged 40 years and
older, by neighbourhood income quintile,
2006/07 LHIN 1 (Erie St. Clair) vs. Ontario
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MethodologyCardiac Procedures

• Cases of coronary angiography, angioplasty and
  isolated bypass surgeries were obtained from the
  Cardiac Care Network of Ontario for fiscal years
  (i.e., April 1 to March 31) 2002/03 to 2006/07
  for Ontario residents aged 20 years and older.
• Exclusions
• Non-Ontario residents, persons less than 20 years
  of age, procedures performed out of hospital or
  abandoned after onset
• Patients who underwent valve surgery at the same
  time as bypass surgery
• Records with missing/invalid age, sex, or LHIN

41
Methodology (contd)Cardiac Procedures

• Census population estimates were used for each of
  the years studied.
• Population estimates by income quintile were
  projected using the income distribution for
  Ontario from the 2001 Census of Canada and
  applying it to the census population estimates
  for each of the years under study.
• The Ontario 2001 census population was used to
  standardize rates.

42
Key FindingsCardiac Procedures

• Volumes (2002/03 to 2006/07)
• Ontario
• The number of coronary angiograms performed
  annually in Ontario increased by 21 from 2002/03
  (almost 47,000 angiograms) to 2006/07 (over
  56,000 angiograms).
• The number of angioplasties performed annually in
  Ontario increased by 48 from 2002/03 (over
  13,000 angioplasties) to 2006/07 (almost 20,000
  angioplasties).
• The number of isolated bypass surgeries performed
  annually in Ontario decreased by 10 from 2002/03
  (almost 8,000 isolated bypass surgeries) to
  2006/07 (almost 7,200 bypass surgeries).

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Annual number of coronary angiograms for
Ontarians aged 20 years and older, 2002/032006/07
44
Annual number of angioplasties for Ontarians aged
20 years and older, 2002/032006/07
45
Annual number of bypass surgeries for
Ontarians aged 20 years and older, 2002/032006/07
46
Key Findings (contd)Cardiac Procedures

• Rates (2002/03-2006/07)
• Ontario
• Over the five-year period, overall age- and
  sex-adjusted rates of coronary angiograms and
  angioplasties increased by 11 and 35,
  respectively. Rates of isolated bypass surgery
  decreased by 18.
• Utilization rates for all three procedures were
  highest among adults aged 65 to 74 years of age,
  corresponding with the average age of patients
  hospitalized with angina and heart attack.
• Overall rates of utilization for each procedure
  were considerably higher in men compared to
  women. The age-specific rates for each procedure
  were consistently higher in men compared to their
  female counterparts. Differences in procedural
  rates between men and women may be attributed to
  factors such as severity of disease and
  concurrent illness.

47
Rate of coronary angiography per 100,000
Ontarians aged 20 years and older, by sex and age
group, 2002/032006/07
48
Rate of angioplasty per 100,000 Ontarians aged 20
years and older, by sex and age group,
2002/032006/07
49
Rate of bypass surgery per 100,000
Ontarians aged 20 years and older, by sex and age
group, 2002/032006/07
50
Key Findings (contd)Cardiac Procedures

• Rates (2006/07)
• Ontario
• Utilization rates for all three procedures were
  lowest among individuals living in the wealthiest
  neighbourhoods (income quintile Q5).
• The disparity in procedure rates (i.e., income
  quintile Q1 vs. Q5) was greater for coronary
  angiography and angioplasty compared to isolated
  bypass surgery (11 vs. 5, respectively).
• Differences in rates between individuals living
  in the poorest and wealthiest neighbourhoods may
  be expected since heart disease is less common in
  people from higher socioeconomic groups.

51
Age- and sex-adjusted rate of coronary
angiography per 100,000 Ontarians aged 20 years
and older, by neighbourhood income quintile,
2002/032006/07
52
Age- and sex-adjusted rate of angioplasty per
100,000 Ontarians aged 20 years and older, by
neighbourhood income quintile, 2002/032006/07
53
Age- and sex-adjusted rate of bypass surgery per
100,000 Ontarians aged 20 years and older, by
neighbourhood income quintile, 2002/032006/07
54
Key Findings (contd)Cardiac Procedures

• Rates (2006/07)
• Local Health Integration Networks (LHINs)
• Two-fold variations in cardiac procedure rates
  were observed across LHINs.
• Utilization was generally similar to that seen at
  the provincial level, in that within each LHIN,
  the overall rate and age-specific rates of each
  cardiac procedure were higher in men compared to
  women.

55
Age- and sex-adjusted rate of coronary
angiography per 100,000 Ontarians aged 20 years
and older, 2006/07
By Local Health Integration Network (LHIN) in
Ontario
56
Age- and sex-adjusted rate of angioplasty per
100,000 Ontarians aged 20 years and older, 2006/07
By Local Health Integration Network (LHIN) in
Ontario
57
Age- and sex-adjusted rate of bypass surgery per
100,000 Ontarians aged 20 years and older, 2006/07
By Local Health Integration Network (LHIN) in
Ontario
58
Rate of coronary angiography per 100,000
Ontarians aged 20 years and older, by sex and age
group, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario
59
Rate of angioplasty per 100,000 Ontarians aged 20
years and older, by sex and age group,
2006/07 LHIN 1 (Erie St. Clair) vs. Ontario
60
Rate of bypass surgery per 100,000
Ontarians aged 20 years and older, by sex and age
group, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario
61
Key Findings (contd)Cardiac Procedures

• Rates (2006/07)
• Local Health Integration Networks (LHINs)
• Although some variation was observed across the
  LHINs, cardiac procedure rates were generally
  higher for individuals living in the poorest
  neighbourhoods (income quintile Q1) compared to
  those living in the wealthiest neighbourhoods
  (income quintile Q5).

62
Age- and sex-adjusted rate of coronary
angiography per 100,000 Ontarians aged 20 years
and older, by neighbourhood income quintile,
2006/07 LHIN 1 (Erie St. Clair) vs. Ontario
63
Age- and sex-adjusted rate of angioplasty per
100,000 Ontarians aged 20 years and older, by
neighbourhood income quintile, 2006/07 LHIN 1
(Erie St. Clair) vs. Ontario
64
Age- and sex-adjusted rate of bypass surgery per
100,000 Ontarians aged 20 years and older, by
neighbourhood income quintile, 2006/07 LHIN 1
(Erie St. Clair) vs. Ontario
65
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MethodologyCataract Surgery

• Cataract surgeries for Ontario were obtained
  using the fee code E140 (cataract surgery) data
  from the Ministry of Health and Long-Term
  CareOntario Hospital Insurance Plan
  (MOHLTC-OHIP) database for fiscal years (i.e.,
  April 1 to March 31) 2002/03 to 2006/07.
• Exclusions
• Non-Ontario residents, persons less than 20 years
  of age
• Records with missing/invalid age, sex, and postal
  code information
• Census population estimates were used for each of
  the years studied.
• Population estimates by income quintile were
  projected using the income distribution for
  Ontario from the 2001 Census of Canada and
  applying it to the census population estimates
  for each of the years under study.
• The Ontario 2001 census population was used to
  standardize rates.

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Key FindingsCataract Surgery

• Volumes and Rates (2002/03-2006/07)
• Ontario
• The annual number of cataract surgeries in
  Ontario increased by 44 from 2002/03 (over
  99,000 procedures) to 2006/07 (almost 143,000
  procedures).
• Over the five-year period, rates of procedures
  adjusted for age and sex increased by 33.

68
Annual number of cataract surgeries for Ontarians
aged 20 years and older, 2002/032006/07
69
Key Findings (contd)Cataract Surgery

• Volumes and Rates (2006/07)
• Ontario
• Overall, cataract surgery was performed most
  frequently among adults between 75 and 84 years
  of age.
• Overall, women had higher rates of cataract
  surgery procedures than men the average crude
  rate for women was 1,721 procedures per 100,000
  compared to 1,250 procedures per 100,000 for men.
  
• Age-specific rates were higher among men aged 85
  years and older compared to their female
  counterparts (6,892 per 100,000 vs. 5,600 per
  100,000).
• Individuals living in low-income neighbourhoods
  (income quintile Q1) were less likely to receive
  cataract surgery than those living in higher
  income neighbourhoodsat least for the first four
  income quintiles. The fourth and fifth income
  quintiles showed similar surgical rates.

70
Cataract surgery rate per 100,000 Ontarians aged
20 years and older, by sex and age group,
2002/032006/07
71
Age- and sex-adjusted cataract surgery rate per
100,000 Ontarians aged 20 years and older, by
neighbourhood income quintile, 2002/032006/07
72
Key Findings (contd)Cataract Surgery

• Volumes and Rates (2006/07)
• Local Health Integration Networks (LHINs)
• Similar to provincial trend with respect to
• Volumes of surgeries being more frequent
  (overall) among women.
• Surgical rates being lowest for persons less than
  65 years of age and highest among persons 75 to
  84 years of age.
• However, comparisons of rates of cataract surgery
  for women and men within the same age category
  did not show a consistent pattern across the
  LHINs.

73
Age- and sex-adjusted cataract surgery rate per
100,000 Ontarians aged 20 years and older, 2006/07
By Local Health Integration Network (LHIN) in
Ontario
74
Age- and sex-adjusted cataract surgery rate per
100,000 Ontarians aged 20 years and older, by
sub-LHIN planning area, 2006/07 LHIN 1 (Erie St.
Clair) vs Ontario
75
Cataract surgery rate per 100,000 Ontarians aged
20 years and older, by sex and age group,
2006/07 LHIN 1 (Erie St. Clair) vs Ontario
76
Age- and sex-adjusted cataract surgery rate per
100,000 Ontarians aged 20 years and older, by
sub-LHIN planning area, 2006/07 LHIN 1 (Erie St.
Clair) vs Ontario
77
Key Findings (contd)Cataract Surgery

• Rates (2006/07)
• Local Health Integration Networks (LHINs)
• For the majority of LHINs, individuals living in
  the lowest-income neighbourhoods (income quintile
  Q1) were less likely to receive cataract surgery
  than those living in the highest-income
  neighbourhoods (income quintile Q5). However, for
  some LHINs surgical rate variation did not appear
  to be associated with income quintile.

78
Age- and sex-adjusted cataract surgery rate per
100,000 Ontarians aged 20 years and older, by
neighbourhood income quintile, 2006/07 LHIN 1
(Erie St. Clair) vs Ontario
79
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MethodologyTotal Hip and Knee Replacement

• Hip and knee replacement cases were obtained from
  the Canadian Institute for Health Informations
  Discharge Abstract Database (CIHI-DAD) from
  fiscal years (i.e., April 1 to March 31) 2002/03
  to 2006/07 for Ontario residents aged 20 years
  and older.
• Exclusions
• Non-Ontario residents, persons less than 20 years
  of age, procedures performed out of hospital or
  abandoned after onset
• Records with missing/invalid age, sex, and postal
  code information
• Census population estimates were used for each of
  the years studied.
• Population estimates by income quintile were
  projected using the income distribution for
  Ontario from the 2001 Census of Canada and
  applying it to the census population estimates
  for each of the years under study.
• The Ontario 2001 census population was used to
  standardize rates.

81
Key FindingsTotal Hip and Knee Replacement

• Volumes and Rates (2002/03-2006/07)
• Ontario
• Volumes of total hip and knee replacement have
  grown substantially between 2002/03 and 2006/07
• 37 for total hip replacement
• 73 for total knee replacement
• The majority of surgeries were planned (elective)
  procedures. In 2006/07, planned procedures made
  up 81 and 92 of total hip and knee
  replacements, respectively.
• Over the five-year period, rates of procedures
  adjusted for age and sex have increased by 28
  for total hip replacement and 61 for total knee
  replacement.

82
Annual number of total hip replacements for
Ontarians aged 20 years and older, by type,
2002/032006/07
83
Annual number of total knee replacements for
Ontarians aged 20 years and older, by type,
2002/032006/07
84
Key Findings (contd) Total Hip and Knee
Replacement

• Volumes and Rates (2006/07)
• Ontario
• Overall, total hip and knee replacement surgeries
  are more commonly performed in women.
• Volumes of total hip and knee replacements are
  performed more frequently among adults between 65
  and 84 years of age, with surgical rates peaking
  among persons aged 75 to 84.
• Age-specific rates for total knee replacement are
  higher among men 85 years and older.
• Rates of total hip and knee replacement were
  lowest in Ontarios poorest neighbourhoods
  (income quintile Q1) and highest in the
  wealthiest neighbourhoods (income quintile Q5).

85
Total hip replacement rate per 100,000 Ontarians
aged 20 years and older, by sex and age group,
2002/032006/07
86
Total knee replacement rate per 100,000 Ontarians
aged 20 years and older, by sex and age group,
2002/032006/07
87
Age- and sex-adjusted total hip replacement
rate per 100,000 Ontarians aged 20 years and
older, by neighbourhood income quintile,
2002/032006/07
88
Age- and sex-adjusted total knee replacement
rate per 100,000 Ontarians aged 20 years and
older, by neighbourhood income quintile,
2002/032006/07
89
Key Findings (contd)Total Hip and Knee
Replacement

• Volumes and Rates (2006/07)
• Local Health Integration Networks (LHINs)
• Similar to the provincial trend with respect to
• Volumes of surgeries being more frequent among
  women.
• Total joint replacement rates being lower for
  persons less than 65 years of age.
• Total joint replacement rates being generally
  lower in the poorest neighbourhoods (income
  quintile Q1) and highest in the wealthiest
  neighbourhoods (income quintile Q5) although
  variation exists among the LHINs.

90
Age- and sex-adjusted total hip replacement
rate per 100,000 Ontarians aged 20 years and
older, 2006/07
By Local Health Integration Network (LHIN) in
Ontario
91
Age- and sex-adjusted total knee replacement
rate per 100,000 Ontarians aged 20 years and
older, 2006/07
By Local Health Integration Network (LHIN) in
Ontario
92
Total hip replacement rate per 100,000
Ontarians aged 20 years and older, by sex and age
group, 2006/07 LHIN 1 (Erie St. Clair) vs Ontario
93
Total knee replacement rate per 100,000
Ontarians aged 20 years and older, by sex and
age group, 2006/07 LHIN 1 (Erie St. Clair) vs
Ontario
94
Age- and sex-adjusted total hip replacement
rate per 100,000 Ontarians aged 20 years and
older, by neighbourhood income quintile,
2006/07 LHIN 1 (Erie St. Clair) vs Ontario
95
Age- and sex-adjusted total knee replacement
rate per 100,000 Ontarians aged 20 years and
older, by neighbourhood income quintile,
2006/07 LHIN 1 (Erie St. Clair) vs Ontario
96
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97
MethodologyCT and MRI scanning

• CT and MRI scans for Ontario were obtained using
  data from the Ministry of Health and Long-Term
  CareOntario Hospital Insurance Plan
  (MOHLTC-OHIP) database for fiscal years (i.e.,
  April 1 to March 31) 2002/03 to 2006/07.
• Exclusions
• Non-Ontario residents
• Inpatient MRI scansthese are not billed to OHIP
  and are covered by hospital global budgets
• Records with missing/invalid age, sex, and postal
  code information
• Census population estimates were used for each of
  the years studied.
• Population estimates by income quintile were
  projected using the income distribution for
  Ontario from the 2001 Census of Canada and
  applying it to the census population estimates
  for each of the years under study.
• The Ontario 2001 census population was used to
  standardize rates.

98
Key FindingsCT and MRI Scanning

• Volumes and Rates (2002/03-2006/07)
• Ontario
• The annual number of CT scans in Ontario
  increased by 56 from 2002/03 (over 950,000 CT
  scans) to 2006/07 (almost 1.5 million CT scans).
• The annual number of MRI scans in Ontario
  increased by 112 from 2002/03 (almost 184,000
  MRI scans) to 2006/07 (just over 389,000 MRI
  scans).
• Over the five-year period, overall age- and
  sex-adjusted rates of CT and MRI scanning
  increased by 44 and 97, respectively.

99
Annual number of inpatient/outpatient CT scans
for Ontarians, 2002/032006/07
100
Annual number of outpatient MRI scans for
Ontarians, 2002/032006/07
101
Key Findings (contd)CT and MRI Scanning

• Volumes and Rates (2006/07)
• Ontario
• CT scanning increased with increasing age. The
  age-specific rates were higher for women less
  than 65 years of age. Men aged 65 years and older
  had higher CT scanning rates than their female
  counterparts.
• The overall rate of MRI scanning was highest in
  those aged 65 to 74 years. The age-specific rates
  were higher for women aged 40 to 74 years. Men
  aged 75 years and older had a higher rate of
  scanning than their female counterparts.

102
Rate of inpatient/outpatient CT scanning per
100,000 Ontarians, by sex and age group,
2002/032006/07
103
Rate of outpatient MRI scanning per 100,000
Ontarians, by sex and age group, 2002/032006/07
104
Key Findings (contd)CT and MRI Scanning

• Rates (2006/07)
• Ontario
• The wealth of the neighbourhood appeared to have
  little impact on the likelihood of an individual
  receiving a CT scan.
• For MRI scanning, rates increased steadily with
  increased neighbourhood income. Individuals
  living in the poorest neighbourhoods (income
  quintile Q1) were 38 less likely to receive an
  MRI scan than those living in the wealthiest
  neighbourhoods (income quintile Q5). The
  disparity between individuals living in the
  poorest and wealthiest neighbourhoods has
  increased over time.

105
Age- and sex-adjusted rate of inpatient/outpatient
CT scanning per 100,000 Ontarians, by
neighbourhood income quintile, 2002/032006/07
106
Age- and sex-adjusted rate of outpatient MRI
scanning per 100,000 Ontarians, by neighbourhood
income quintile, 2002/032006/07
107
Key Findings (contd)CT and MRI Scanning

• Volumes and Rates (2006/07)
• Local Health Integration Networks (LHINs)
• CT scanning
• As was observed at the provincial level,
  utilization increased sharply with increased age.
• Age-specific rates between men and women in the
  same age category did not show a consistent
  pattern as that observed at the provincial level.
  For example, rates of CT scanning for women were
  not consistently higher for women less than 65
  years of age.
• MRI scanning
• Utilization by age was generally similar to that
  observed at the provincial level in that scanning
  was performed most frequently among adults aged
  65 to 74 years.
• In contrast to those observed at the provincial
  level, age-specific rates between men and women
  in the same age category did not show a
  consistent pattern. For example, rates of MRI
  scanning were not consistently higher among women
  less than 75 years of age.

108
Age- and sex-adjusted rate of inpatient/outpatient
CT scanning per 100,000 Ontarians, 2006/07
By Local Health Integration Network (LHIN) in
Ontario
109
Age- and sex-adjusted rate of outpatient MRI
scanning per 100,000 Ontarians, 2006/07
By Local Health Integration Network (LHIN) in
Ontario
110
Age- and sex-adjusted rate of inpatient/outpatient
CT scanning per 100,000 Ontarians, by sub-LHIN
planning area, 2006/07 LHIN 1 (Erie St. Clair)
vs. Ontario
111
Age- and sex-adjusted rate of outpatient MRI
scanning per 100,000 Ontarians, by sub-LHIN
planning area, 2006/07 LHIN 1 (Erie St. Clair)
vs. Ontario
112
Rate of inpatient/outpatient CT scanning per
100,000 Ontarians, by sex and age group,
2006/07 LHIN 1 (Erie St. Clair) vs. Ontario
113
Rate of outpatient MRI scanning per 100,000
Ontarians, by sex and age group, 2006/07 LHIN 1
(Erie St. Clair) vs. Ontario
114
Age-adjusted rate of inpatient/outpatient CT
scanning per 100,000 Ontarians, by sex and
sub-LHIN planning area, 2006/07 LHIN 1 (Erie St.
Clair) vs. Ontario
115
Age-adjusted rate of outpatient MRI scanning per
100,000 Ontarians, by sex and sub-LHIN planning
area, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario
116
Key Findings (contd)CT and MRI Scanning

• Rates (2006/07)
• Local Health Integration Networks (LHINs)
• CT scanning
• The association between neighbourhood income
  quintile and rates of scanning varied by LHIN.
  For the majority of LHINs, individuals in the
  poorest-income neighbourhoods (income quintile
  Q1) were more likely to receive a CT scan than
  individuals in the highest-income neighbourhoods
  (income quintile Q5). For some LHINs, CT scanning
  rates increased with increasing neighbourhood
  income. This variation may explain the lack of an
  association between neighbourhood income and CT
  utilization at the provincial level

117
Key Findings (contd)CT and MRI Scanning

• Rates (2006/07)
• Local Health Integration Networks (LHINs)
• MRI scanning
• MRI scanning rates by neighbourhood income
  quintile generally showed a consistent
  patternwith the exception of the North West
  LHINin that individuals living in the poorest
  neighbourhoods (income quintile Q1) were less
  likely to receive an MRI scan than those living
  in the wealthiest neighbourhoods (income quintile
  Q5). Over the five-year period, the disparity in
  MRI scanning rates between those living in the
  wealthiest and poorest neighbourhoods appears to
  have increased for the majority of LHINs.

118
Age- and sex-adjusted rate of inpatient/outpatient
CT scanning per 100,000 Ontarians, by
neighbourhood income quintile, 2006/07 LHIN 1
(Erie St. Clair) vs. Ontario
119
Age- and sex-adjusted rate of outpatient MRI
scanning per 100,000 Ontarians, by neighbourhood
income quintile, 2006/07 LHIN 1 (Erie St. Clair)
vs. Ontario
120
Interpretive Cautions

• Volumes and rates may not reconcile with those
  produced in previous editions of Access to Health
  Services in Ontario Atlases due to refinements in
  the patient assignment methodology to LHINs and
  updates to the postcensal population estimates.
• LHIN-level analyses were based on the LHIN where
  the patient lived, which may not be the same as
  the LHIN where the procedure/imaging was
  performed.
• Cases (for total hip and knee replacement) were
  counted by hospital separations and were not
  based on the number of procedures performed.
• For total hip and knee replacement surgeries,
  mandatory coding of revisions in CIHI-DAD began
  in 2003/04. The volume of revision procedures may
  have been underestimated before 2003/04.
• Low rates of surgery in some LHINs may not
  indicate suboptimal access but instead may
  reflect preferential use of an alternative type
  of surgery within that particular LHIN (e.g.,
  breast conserving surgery vs. mastectomy ).

121
Interpretive Cautions (contd)

• Clinical reasons for differences in CT/MRI
  utilization rates cannot be determined from
  analyses of Ontario administrative databases
  since they do not contain data indicating why the
  CT or MRI scan was ordered.
• The relationship between utilization of services
  and socioeconomic status as measured by
  neighbourhood income quintile requires further
  study. With the exception of CT scanning, where
  income appeared to have little impact upon CT
  utilization, rates of hip and knee replacement,
  cataract surgery and MRI scanning by
  neighbourhood income quintile appear more
  disparate between individuals in the poorest and
  wealthiest neighbourhoods (i.e., Q1 vs. Q5). If
  utilization was solely based on medical need,
  higher utilization would be expected for
  individuals living in poorer neighbourhoods.
• The variability in rate estimates (i.e.,
  wide/overlapping confidence intervals between
  income quintiles) should also be given
  consideration in reviewing and interpreting rates
  by neighbourhood income.

122
Interpretive Cautions (contd)

• Trends in rates of service provision is one
  indicator of access to care. Other factors to
  consider include
• Patterns of disease burden
• Unmet need
• Appropriateness of surgery
• Patient preferences
• Time spent waiting for surgery
• Patient outcomes