1. Overview Finding and Using Health Statistics and Data FilesSoc 398: Social Inequality and Health Darlene Fichter Data Library Services, U of S Library October 4, 2007

2. Overview • Why use data? • Types of Data Resources in the Library and Internet: Health Surveys • Aggregate data • Public Use Microdata Files • Surveys and Products • Finding a data file • Understanding data documentation

3. Data Tells a Story Manual workers die earlier than others Men: 7.4 years Life expectancy at birth: by social class and sex, 1997-99, England & Wales http://www.statistics.gov.uk/cci/nugget.asp?id=1007

4. Finding the Stories • Debunking third-world myths with the best stats you've ever seen – Hans Rosling • Global Life Expectations • How can we use this data? http://www.ted.com/index.php/talks/view/id/92

5. Social Inequality and Health • Advances of medical practice and science have been seen as the principal causes of increased human life expectancy True False

6. Social Inequality and Health • Nutrition and improved living conditions are better indicator of population health True False

7. What are some risk factors of lower socio-economic status? • Smoking • Lack of exercise • Immoderate eating and drinking • High fat/low fiber diets • More stress - higher rates of ill health/death • Lower of levels of social support • Live or work in environments hazardous to health

8. Overview Part 1: Health Surveys

9. Health Statistics • Two main sources of data: • Special surveys by Statistics Canada • Administrative data • Collected by law – causes of death, notifiable diseases • Collected by Dept. of Health

10. Types of Data Files • Aggregate data files • Counts • Cases of measles in Saskatoon • Cross tabulations • Number of smokers in Saskatoon by age and sex

11. Table 105-0005 - Risk of depression, by age group and sex, household population aged 12 and over, Canada(Canadian Community Health Survey)

12. Microdata File • Raw data organized in a file where the records or lines in the file are observations of a specific unit of analysis • Each record or line is one person’s responses • Time use survey – exercising, shopping, working, TV, gardening, eldercare

13. Cases 3 & 4 from the General Social Survey 2 Main File Sex ID 000031214110011982001212222221002098200121222222401121111241112121112205020197111971021212222225211026121204300140955720411313022111999901978787879702221411271412400315000616611232222222221111172626162212222666666636212000000020320222224222000022204141101101102111111122111000000210000000002100000000010000000000200000423300200200100000100200 000041100110011101102122222221002009200212222222021111111231212111211208120193811938044122222221111052201203901007504721031191012233520406058787870304221303420708300400001420007111222122211721575656565555555666666656565000555500210222111111110000001111100001101112212122111011010110000110101100000000000000000000000000000000000000000000000000 Case 3 Case 4

14. Public Use Microdata File - PUMF • Specially prepared file to minimize disclosure • “Master file” would have personal identifiers

15. Population Health Surveys1 • Understand the determinants of health • Collect data on • Economic • Social • Demographic • Occupational and environmental correlations • Can impact public policy development 1 Health Survey information based on Michel B. Seguin’s “Health Statistics Information on the STC website”. December 2003.

16. Population Surveys • NPHS – National Population Health Survey • Household, institutional, north (territories) • Geography - provincial • Products • Public Use Microdata Files (PUMF) • 1994-1995 • 1996-1997 • 1998-1999 • Research Data Centre access • 2000-2001 • 2002-2003 • 2004-2005 • 2006-2007 NPHS is a longitudinal survey. PUMF are not longitudinal, due to the high risk of disclosure. Inactive

17. NPHS • The NPHS, which relies on respondents' self-reported health information, surveys the same group of respondents every two years for up to 20 years

18. Population Surveys • Canadian Community Health Survey (CCHS) • Common content • Optional content • 126/136 health regions, started September 2000

19. Canadian Community Health Survey • Cycle 1.1 – Large sample (2001) • Cycle 1.2 – Mental Health (2002) • Cycle 2.1 – Large Sample (2003) • Cycle 2.2 – Nutrition (2004) • Cycle 3.1 – Large Sample (2005) • Cycle 3.2 – Canadian Health Measures Survey (CHMS)

20. Article from Nutrition cycle

21. Health Indicators • Measures of health status, health system and factors that influence health • Based on comparable definitions • Geography • Canada • Provinces • Regionally

22. Health Indicators • Health Status • Health conditions, human function, well-being, deaths • Health Determinants • Health behaviours, living & working conditions, personal resources(income), environmental factors • Health System Performance • Effectiveness, accessibility, efficiency, safety … • Community/health system characteristics

23. Health Indicators • Many data sources • Statistics Canada • Vital statistics • Surveys • Canadian Institute for Health Information (CIHI) • Provincial ministries • Health Canada • Hospital morbidity and discharge databases, …

25. Health Indicators • Has the notion of “peer groups” where Health regions with similar socio-economic characteristics are grouped • Products (free) • Publication online • Tables on Statistics Canada & CIHI web sites

26. Health Region Boundaries • Show your results spatially Distribution gender differences in depression compared to Calgary Health Region

27. Comparable Health Indicators • Grew out of the First Minister’s meeting in 2000 • 14 areas of comparable health status and health system performance • Geography • Provincial

28. Comparable Health Indicators - Topics • Health Status • Live expectancy, infant mortality, low birth rate, self-reported health • Health Outcomes • Change in life expectancy, improved quality of life, reduced burden of disease, illness or injury • Quality of Service • Waiting times (selected services), patient satisfaction, Hospital readmission (selected), access to 24/7 first contact health services, home and community services, public health surveillance and protection, health promotion and disease prevention

29. Products • Available from Statistics Canada Web Site & CANSIM • Web Site: • http://www.statcan.ca/english/freepub/82-401-XIE/01002/tables.htm

30. Other Tables • Causes of Death • Cancer Statistics

31. Health Canada's Notifiable Diseases Online Infectious Diseases http://www.phac-aspc.gc.ca/id-mi/

32. Residential Care Facilities • Some older tables at CIHI, prior to 1999 • Custom tabulation • Online tables will be available for recent survey

33. Health Information from CIHI

34. CIHI Topics

35. CIHI Products • Publicly available, aggregate-level data • Analytic reports • Links to Saskatchewan report of Comparable Health Statistics with a study on measles • More detailed statistics may make a custom data request

36. General Social Surveys • Cycle 1 to Cycle 19 • Monitor changes in the health of Canadians and to examine social support. • Cycles cover and repeat content and special focus areas • Each cycle includes general socio-economic variables

37. Cycle 1 - 10

38. Cycle 8 - 19 Since 1994, health as core topic covered in NPHS, social support expanded in 1996.

39. General Social Survey 20 - 22 • 20 - Family Transitions Survey • Family data collected in cycle 5, 10, 15 • 21 - Family, Social Support and Retirement • 22 – Survey on Social networks

40. National Longitudinal Survey of Children and Youth (NLSCY) • Longitudinal survey designed to measure child development and well-being as children grow from infancy to childhood • Products • PUMF • 1994-95-Cycle 1 • 1996-97-Cycle 2 • 1998-99-Cycle 3 • … Cycle 6 2004-2005

41. National Longitudinal Survey of Children and Youth (NLSCY) • Products • Cycle 1, 1994-1995 - Synthetic Files for Remote Access to the Master Files • Research Data Centre

42. Health and Activity Limitation Survey • Post-censual survey • Products • 1991 PUMF • 1996 PUMF • 2001 - Participation and Activity Limitation Survey (PALS) • 2006 - Participation and Activity Limitation Survey (PALS)

43. International • SourceOECD • Comparable statistics on health and health systems across OECD countries • Health status, expenditure, financing • Health care utilization • Health care coverage • Pharmaceutical • Non-medical determinants to health • Some U.S. and European data

44. Human Activity and The Environment 2000 • Human activity and its relationship to natural systems' air, water, soil, plants and animals • Aggregate tables

45. Questions ?

46. Overview Part 2: Finding a Statistics and Data

47. Ways to Find Files • Library Catalogue • Statistics Canada Catalogue • Data Library Web Site • Web Data Extractors, i.e.IDLS • Talk to the Reference staff or Data Library staff

48. 1. The Catalogue • Use it when you know the name of the survey • Canadian Community Health Survey is footnoted in the article Mental Health of Canada’s Immigrants. • Searching by a topic • Strategies • Keep it broad – “health” not measles • Use “statistics” or “codebook” • Change the scope to “Data and GIS Files”

49. 2. Statistics Canada Catalogue • Enter your keywords: internet use • Look for the words public use microdata file or CANSIM Look for free access from our library

50. 3. Data Library Web Site • Browse by subject Health