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ARCHIVED - A Statistical Profile on the Health of First Nations in Canada: Health Services Utilization in Western Canada, 2000

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Health Canada
June 2009
Health Canada Pub.: 3557
Cat: H34-193/4-2008E-PDF
ISBN: 978-0-662-48923-8

© Her Majesty the Queen in Right of Canada, represented by the Minister of Health Canada, 2009

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Table of Contents

List of Figures

Figures

Health Canada is the federal department responsible for helping the people of Canada maintain and improve their health. We assess the safety of drugs and many consumer products, help improve the safety of food, and provide information to Canadians to help them make healthy decisions. We provide health services to First Nations people and to Inuit communities. We work with the provinces to ensure our health care system serves the needs of Canadians.

Published by authority of the Minister of Health.

A Statistical Profile on the Health of First Nations in Canada: Health Services Utilization in Western Canada, 2000 is available on the website of the First Nations and Inuit Health Branch.

Également disponible en français sous le titre :

Profil statistique de la santé des Premières nations au Canada : Utilisation des services de santé dans l'Ouest canadien, 2000

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Highlights

  • This report presents information on health service utilization in the year 2000 by the First Nations on- and off- reserve population as identified in the British Columbia, Alberta, Saskatchewan and Manitoba provincial hospital administrative databases. Hospital separation data from the other provinces and territories were not available. As such, caution should be used when interpreting the data.
  • The leading causes (as categorized by the International Classification of Diseases, Version 9 codes) of hospital separations for First Nations were 'Complications of Pregnancy, Childbirth and the Puerperium', 'Respiratory Diseases' and 'Injury and Poisoning'.
  • First Nations hospital separation rates were higher than the Western population rates for all causes except for 'Perinatal Conditions' and 'Congenital Anomalies'.
  • First Nations hospital separation rates were higher than the Western population rates for all pregnancies, childbirth and the puerperium; ischemic heart disease; cerebrovascular disease; diabetes; chronic obstructive pulmonary disease; pneumonia and influenza; external causes of injury; and lung, colorectal and cervical cancers.
  • Hospital separation rates for asthma and bronchitis in the First Nations population were higher compared to the Western population. The highest rates were seen in the less than one year age group.
  • Hospital separation rates for diabetes in the First Nations population were higher than the Western population from age 20 years onward, with rates in the First Nations female 55 to 59 year age group being 15 times higher.
  • Rates for both pneumonia and influenza were approximately four times higher in the First Nations population than in the comparative Western population.
  • Rates of intentional and unintentional injuries among First Nations were five and four times higher, respectively, than the rates in the comparative Western population.
  • The leading causes of hospital separations due to injury among First Nations males were falls, assault, motor/road vehicle collisions, and surgical complications. For First Nations females, the leading causes were falls, suicide/self-injury, surgical complications and motor/road vehicle collisions.

Introduction

This report presents information on health service utilization in the year 2000 by the First Nations on- and off-reserve population as identified in the British Columbia, Alberta, Saskatchewan and Manitoba provincial hospital administrative databases. Data for the other provinces and territories are not included in this report as they were not able to identify First Nations populations in their databases. Health service utilization is reported in terms of hospital separation rates and average length of stay. Hospital separations and average length of stay provide an idea of which diseases or disorders place the greatest demand on the health care system.1 Health service utilization data provide some insight into the health of a population and may be used to determine where prevention efforts should be concentrated to avert illness with the goal of reducing burden on the health care system. These data, however, cannot provide accurate estimates of the prevalence of a particular disease or disorder within that population.1 This report focuses on the health conditions that are the most common causes of hospital separations in the First Nations population:

  • pregnancies, childbirth and the puerperium with or without complications;
  • chronic diseases such as circulatory disease, cancer and diabetes;
  • respiratory diseases; and
  • injury and poisoning.

This report differs from previous editions of A Statistical Profile on the Health of First Nations in Canada, as each chapter is now being published as a stand-alone report. As such, it is not a continuation of the previous edition of the series containing 1997 statistics. It should be noted that the population base used in this report and the method of rate calculation differs from previous reports and thus, should not be compared to previously published results.

The publication of this report would not be possible without the contribution of First Nations and Inuit Health Branch, Regions and Programs Branch, and the Health Data Technical Working Group. Their hard work and dedication is gratefully acknowledged and further listed in the Acknowledgements section of this report.

Health Canada Activities

The First Nations and Inuit Health Branch of Health Canada supports the delivery of public health and health promotion services on-reserve and in Inuit communities, and provides some targeted services off-reserve and in urban centres. It provides drug, dental and ancillary health services, regardless of residence. First Nations and Inuit Health Branch also provides primary care services on-reserve in remote and isolated areas, where there are no provincial services readily available. As of May 2008, First Nations and Inuit Health Branch funded over 500 health facilities across the country, including 74 nursing stations, 222 health centres, 41 alcohol and drug treatment centres, and 9 solvent abuse centres. Home and community care were provided in 600 communities, and primary health care was provided in approximately 200 remote communities.

First Nations and Inuit health programs are delivered across the country through the collaborative efforts of headquarters and regional employees working in partnership with First Nations and Inuit communities. Regional offices are located in every province, with the exception of the Atlantic Provinces, which are represented by the Atlantic Region located in Halifax, Nova Scotia. The Northern Region (formerly the Northern Secretariat) - located in Ottawa and Whitehorse - is responsible for programs in the Northwest Territories, the Yukon and Nunavut. Each region has its own unique characteristics. First Nations and Inuit Health regional staff (members of the Regions and Programs Branch) have a critical role to play in ensuring that programs and services effectively respond to the needs of communities within their jurisdiction.

In order to effectively carry out its role, First Nations and Inuit Health Branch, as with First Nations and Inuit communities, needs information on population health status, health determinants and risk factors. To this end, the regional offices collect and report information from various sources. Territories are not required to report vital statistics as they have responsibility for primary health care; however, mandatory reporting requirements are in place for First Nations and Inuit Health Branch-funded programs including communicable disease control and environmental health initiatives.

Communicable disease control includes reporting on immunization levels (by age, sex and antigen). This reporting may be required by provincial regulations. For diseases with epidemic potential, the provincial, territorial and regional offices require notification within 24 hours. It should be noted that legislation to support communicable disease control is under the domain of provincial and territorial governments.

Environmental health information, in relation to First Nations and Inuit Health Branch programs, includes the total number and percentage of facilities meeting provincial, territorial or federal health and environmental standards for food services, water supply, sewage and garbage, pollution and hazardous substances. Within 24 hours, communities must also notify Health Canada of any environmental hazards or conditions that may have significant environmental impacts, including the steps taken to remedy the situation.

Further information on the past and present role of Health Canada in delivering services to First Nations and Inuit can be found on the First Nations and Inuit Health Branch website.

Provincial and Territorial Activities

Health care in Canada is largely under provincial and territorial jurisdiction. As such, First Nations and Inuit individuals obtain much of their care from the provincial and/or territorial health systems, including hospitals or physicians in private practice, and these data are held in provincial/territorial databases. Other health services (such as dental care, prescriptions and medical supplies) as well as allied health services situated outside of hospitals (such as mental health services, community-based prevention and home care) are generally not provided by provincial governments to First Nations on-reserve. The costs of these additional health services fall to the federal jurisdiction, under the policy of Health Canada. For example, the federal government pays for health professionals such as dentists, dental therapists and optometrists who provide services to remote and isolated communities on a visiting basis, or for First Nations and Inuit travelling to larger centres for specialized or emergency treatments.

Data Sources

First Nations Hospitalizations

Hospitalization data among First Nations included in this report originate from the provincial hospital administrative databases of the four western provinces: Manitoba, Saskatchewan, Alberta and British Columbia, accounting for 60% of the total Canadian First Nations population.2 Each provincial database uses different methods to identify First Nations populations. At the time of data collection, some provinces could identify First Nations from their health card registration numbers while others relied on previous data linkages to files such as Provincial Health Premium lists, Health Canada's Status Verification System, or Indian and Northern Affairs Canada's Indian Registry.

Provincial and territorial governments also have varying capacities to extract and analyze First Nations and Inuit data from their hospital databases. Two provinces, British Columbia and Alberta, identify First Nations clients in their databases through unique health card numbers or First Nations health premium lists. Using this method, Alberta estimates that their hospital registration files have 25 to 35% greater numbers of First Nations than Indian and Northern Affairs Canada reports for the Alberta population.3 While Manitoba Health has a First Nations identifier within the Manitoba Health Services Commission registry, the identifier is missing from approximately 35% of the First Nations population of whom the majority are Bill C-31 reinstatements. Saskatchewan uses self-identification and address information to determine status. Other criteria come into play in identifying First Nations from health premium files, or based on postal or geographic identifiers that can affect the completeness of the reported data. Files derived from linkages are limited to the latest updated files as well as the selection criteria and accuracy of the files.

It should be noted that data received from the provinces were for the calendar year 2000 rather than the conventional fiscal year, therefore, only hospital stays that ended during 2000 were included in the analysis. As well, there were differences in data collection methods and completeness; thus, comparisons between regions could not be made with the First Nations data.

The hospital separation data from Alberta originate from a database developed specifically for another project and not the complete provincial hospital administrative database. For this reason, analysis of certain indicators does not include Alberta data, as it was not possible to identify specific International Classification of Diseases, Version 9 codes below the International Classification of Diseases, Version 9 chapter level. In addition, Saskatchewan excluded the majority of live births from their hospitalization data.

Hospital separation data for other regions could not be obtained, thus the data reported are the best estimates that we have for this time period.

Canadian Hospitalizations

Hospitalizations for the Western population originate from the Hospital Morbidity Database, a national data holding managed by the Canadian Institute for Health Information. The Hospital Morbidity Database captures administrative (for example, admission and discharge dates), clinical (for example, most responsible diagnosis) and demographic (for example, patient age) information on hospital in-patient events and provides national discharge statistics from Canadian health care facilities by diagnoses and procedures. Discharge data are received from acute care facilities and select chronic care and rehabilitation facilities across Canada. Discharge data from psychiatric facilities as well as day procedures (for example, day surgeries) and Emergency Department visits are not captured in this database.

The Hospital Morbidity Database is populated by a subset of data from the Discharge Abstract Database, also managed by the Canadian Institute for Health Information. The Discharge Abstract Database contains data from over 75% of Canadian hospitals, and focuses on in-patient care and day surgery. The Hospital Morbidity Database differs from the Discharge Abstract Database in that it appends data from non-Discharge Abstract Database jurisdictions so that it is nationally comprehensive.

The Hospital Morbidity Database captures up to five diagnoses, however, in this analysis, only the primary diagnosis is examined. Using only the primary diagnosis for hospital separations in the rate calculation creates an underestimate, which is most notable in the least serious conditions such as skin diseases and nervous system diseases.4 However, overestimation due to more than one hospitalization in a given year is more notable for chronic diseases.

Hospital separation data are affected by many factors other than health status. These factors include the availability of care, physical and financial accessibility, administrative decisions and hospital specialization.4

Methods and Limitations

This report uses information on health service utilization in the year 2000 by the First Nations on- and off-reserve population as identified in the British Columbia, Alberta, Saskatchewan and Manitoba provincial hospital administrative databases. Hospital separation data from the other provinces and territories were not available. As such, caution should be used when interpreting the data.

Hospital Separations

Hospital separations, or discharge statistics, are recorded whenever an individual is discharged from a hospital, either alive (including return to residence or transfers) or deceased. Since a person can be discharged a number of times in a single year, these data describe hospital separations (discharges), not individuals. As a result, hospital separations cannot be used to measure the prevalence of a disease or disorder. Hospital separations do not include out-patient, same-day services, or procedures conducted in a hospital without admission.

Hospital separation data can be analysed in several ways, such as by primary diagnosis, procedure performed, or length of stay in hospital. For the purposes of this report, hospital separation data have been analysed using the primary diagnosis, which is defined as the main cause of the hospitalization, and external causes (External Causes of Injury codes) for select injury and poisoning data.

Classification of Diagnoses

In this report, hospital separations are classified using International Classification of Diseases, Version 9 coding. Details of codes and adapted terminology are provided in Appendix 1.

The International Classification of Diseases, Version 9 hospital separations for infectious diseases were only analyzed at the chapter level. The majority of individuals are not hospitalized for communicable diseases; as such the inclusion of hospital separation data for such diseases could present a skewed picture of the incidence of communicable disease in Canada. Separate data are presented for pneumonia and influenza, as these diseases have an important impact on health care utilization among First Nations, including hospitalizations.

Rates of Hospitalization

Hospital separation rates were calculated for the First Nations population and compared to the Western population (identified in the Hospital Morbidity Database), where applicable. In this report, hospital separations are reported as crude, age-specific or age-standardized rates (described in detail as part of this section and depicted in the Method of Rate Calculation box). When interpreting rates, it is important to note that the age structure of the First Nations population differs from that of the Western population in that the First Nations population is younger (Figure 1). It was necessary to adjust for the effect of age in order to be able to make meaningful comparisons between First Nations and the Western population.

Figure 1. Age Distribution of First Nations and General Population, Western Canada, 2000

Figure 1. Age Distribution of First Nations and General Population, Western Canada, 2000

1. Includes the provinces of British Columbia, Alberta, Saskatchewan and Manitoba.

Note:
Includes Registered Indians living on- and off-reserve.
Source: Population Projections of Registered Indians, 2000-2021, Indian and Northern Affairs Canada, 2002; Statistics Canada, CANSIM Table 051-0001.

Population (Denominator)

To calculate valid rates, it is necessary to use numerator and denominator data that relate to the same populations. For this report, there were several populations that could be used for the denominator but only one for the numerator (hospital separations); accordingly, each region provided a denominator that best corresponded to the numerator provided. This resulted in four different denominators being used, with varying levels of population coverage. Since this report is intended to provide an overall picture, it was necessary to combine the data from the four regions. To ensure a common denominator consistent across the regions, the populations from all four were adjusted to a standard population - the Status/Registered First Nations on- and off- reserve population as of December 31, 2000.5 The Indian Register is the official record kept by Indian and Northern Affairs Canada of all Status/Registered Indians in Canada and is adjusted for late and under-reported births and deaths by Statistics Canada.5 Our adjustment procedure decreases the population for British Columbia and Alberta and increases the population for Saskatchewan and Manitoba.

This adjusted population was stratified by age, sex, and region in order to obtain the appropriate denominator for each health condition in this report.

Rate Calculation

Calculations used in this report are defined as follows:

Crude rate: divides the estimated total number of hospital separations by the total population, expressed as hospital separations per 100,000 population.

Age-specific rate: divides the total number of hospital separations for a specified age group by the resident population of the same age group, expressed as hospital separations per 100,000 population.

Age-standardized rate: multiplies the age-specific separation rate by the standard population of the same age group, expressed as hospital separations per 100,000 population. Age-standardized separation rates were calculated to allow for comparisons between the two populations (that is to say, hospital separations for First Nations versus hospital separations for the Western population). The age-standardized separation rate represents what the crude rate would have been in the study population if that population had the same age distribution as the standard population, which in this report is the 1991 Western Canadian population.6

Method of Rate Calculation

The formulae used for the rate calculations are found in the Method of Rate Calculation box. For each region, age-specific separation rates were calculated using the regional number of hospitalizations in each age group divided by the age-specific regional population (provided by the region). Next, these rates were multiplied by the Indian and Northern Affairs Canada population to estimate the number of hospitalizations for each age group that would have occurred in the region if the regional population were identical to the Indian and Northern Affairs Canada population. This method assumes that the First Nations population as defined by the provincial Department of Health is a representative sample of the entire Indian and Northern Affairs Canada population for the province. This calculation was done for each region. The estimated number of hospitalizations was then summed for each age group across each region. The summed total for each age group was then divided by the respective summed age-specific Indian and Northern Affairs Canada population for the four regions (British Columbia, Alberta, Saskatchewan, Manitoba), to get the age-specific separation rate. To calculate the age-standardized separation rate, these age-specific rates were then multiplied by the corresponding age group of the 1991 Western Canadian population, added together, and divided by the total 1991 Western Canadian population. The calculated rates were rounded to the nearest 10 to reflect that the calculation method produces an estimated number only. (See Appendix 2 for a rate calculation example.)

Comparisons

In this report, health services utilization among First Nations is compared to utilization in the population of Western Canada (Western population). The latter includes only those provinces for which comparable First Nations data were available (that is to say, British Columbia, Alberta (when available), Saskatchewan and Manitoba). Ratios (relative comparisons) and differences (absolute comparisons) were calculated to enable a single figure comparison of health services utilization of the two separate population groups (First Nations and Western population), and are defined as follows:

Rate ratio: divides the age-standardized separation rate of the First Nations population by the age-standardized rate for the Western population. A rate ratio of 1.0 indicates that the First Nations and Western population both experience the same hospital separation rate. A rate ratio greater than 1.0 indicates that First Nations people are more likely to be hospitalized, while a rate ratio less than 1.0 indicates that First Nations people are less likely to be hospitalized compared to the Western population.

Rate difference: subtracts the age-standardized separation rate for the Western population from the age-standardized separation rate for the First Nations population. A positive rate difference indicates the excess separation rate in the First Nations population.

Method of Rate Calculation for First Nations Populations

I. Regional Age-Specific Calculation

For each region, regional age-specific rates were calculated using the following formula:

ai = bi/ci

Where
a = regional age-specific rate
b = number of regional hospital separations
c = regional population
i = age group (<1, 1-4, 5-9,..., 85+)

II. Estimated Number of Regional Hospital Separations Using the Indian and Northern Affairs Canada Population

The estimated number of hospital separations in each region by age group, had the regional population been the same as the Indian and Northern Affairs Canada population for each region, was calculated using the following formula:

ei = ai*di

Where
e = estimated number of hospital separations, by region, using the Indian and Northern Affairs Canada population
a = regional age-specific rate
d = Indian and Northern Affairs Canada regional population
i = age group (<1, 1-4, 5-9,..., 85+)

III. Western Canadian Age-Specific Rates

The estimated number of regional hospital separations calculated in step II were summed across the four regions for each age group and used to calculate the Western Canadian age-specific rates using the following formula:

fi = (∑ei/∑di)*100,000

Where
f = Western Canadian age-specific rate
e = estimated number of hospital separations, by region, using the Indian and Northern Affairs Canada population
d = Indian and Northern Affairs Canada regional population
i = age group (<1, 1-4, 5-9,..., 85+)

IV. Western Canadian Age-Standardized Rate

The Western Canadian age-standardized rate was calculated using the following formula:

g = [∑(fi*hi)/∑hi]*100,000

Where
g = Western Canadian age-standardized rate
f = Western Canadian age-specific rate
h = 1991 Western Canadian population
i = age group (<1, 1-4, 5-9,..., 85+)

Average Length of Stay

Data on Average Length of Stay, in combination with data on hospital separations, provide an idea of which diseases or disorders place the most demand on the health care system.1 It also an indirect indicator of health in a population; while it may also reflect the efficiency of a health care system.1 Generally, Average Length of Stay is calculated by dividing the total number of days spent in hospital by the number of hospital separations.1

Regional age-specific bed-day rates were calculated and multiplied by the regional Indian and Northern Affairs Canada population to estimate the total regional bed-days (method similar to regional age-specific hospital separation rates). These were then summed across the four regions and divided by the Indian and Northern Affairs Canada population for those regions to yield Western Canadian age-specific bed-day rates. The Western Canadian age-specific bed-day rates were weighted by the corresponding age groups of the 1991 Western population to yield the Western Canadian age-standardized bed-day rate. This rate was divided by the Western Canadian age-standardized separation rate (calculated above), to yield the age-standardized Average Length of Stay for First Nations in Western Canada.

Results and Discussion

This report uses information on health service utilization in the year 2000 by the First Nations on- and off-reserve population as identified in British Columbia, Alberta, Saskatchewan and Manitoba provincial hospital administrative databases. Hospital separation data from the other provinces and territories were not available. As such, caution should be used when interpreting the data.

All Causes of Hospitalizations

The leading causes of hospital separations for First Nations were 'Complications of Pregnancy, Childbirth and the Puerperium', with a crude separation rate of 6,960 hospital separations per 100,000 population, followed by 'Respiratory Diseases' and 'Injury and Poisoning', with crude separation rates of 2,310 and 2,090 hospital separations per 100,000 population respectively (Figure 2).

Figure 2. Crude Hospital Separation Rates for Individual Causes by International Classification of Diseases, Version 9 Chapter, First Nations, Western Canada, 2000

Figure 2. Crude Hospital Separation Rates for Individual Causes by International Classification of Diseases, Version 9, Chapter, First Nations, Western Canada, 2000

1. International Classification of Diseases, Version 9 chapter titles and associated codes can be found in Appendix 1.
2. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba only.

Notes:
a) For Complications of Pregnancy, Childbirth and the Puerperium, the female population was used as the denominator instead of the total population in the calculation of rates.
b) Detailed rates can be found in Appendix 3.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health.

As shown in Figure 3, age-standardized hospital separation rates for First Nations were higher than the Western population separation rates for all causes except for 'Perinatal Conditions' and 'Congenital Anomalies'. Of all primary diagnoses, 'Complications of Pregnancy, Childbirth and the Puerperium' had the highest age-standardized separation rate (6,190 hospital separations per 100,000 population). This separation rate was approximately two times higher than the Western population separation rate (3,310 hospital separations per 100,000 population). The next three age-standardized separation rates, 'Respiratory Diseases', 'Digestive Diseases' and 'Injury and Poisoning', were approximately three times higher than the corresponding Western population separation rates. The largest First Nations to Western population ratio was seen in the 'Endocrine and Immune' category with a First Nations separation rate almost five times higher than the Western population separation rate.

Figure 3. Age-standardized Hospital Separation Rates by International Classification of Diseases, Version 9 Chapter, First Nations and General Population, Western Canada, 2000

Figure 3. Standardized Hospital Separation Rates by International Classification of Diseases, Version 9, Chapter, First Nations and General Population, Western Canada, 2000

1. The 1991 populations for British Columbia, Alberta, Saskatchewan, and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Nineteen First Nations separations with unknown age group, twenty-seven Western population separations with unknown separation date, and sixteen Western population separations with unknown age were not included in the totals for the calculation of rates.
3. International Classification of Diseases, Version 9 chapter titles and associated codes can be found in Appendix 1.
4. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba.
5. Includes the provinces of British Columbia, Alberta, Saskatchewan and Manitoba.

Notes:
a) For Complications of Pregnancy, Childbirth and the Puerperium, the female population was used as the denominator instead of the total population in the calculation of rates.
b) Detailed rates can be found in Appendix 3.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

The absolute difference between the First Nations and Western population separation rates was examined. The top three causes of hospital separations for First Nations adding to the burden of health were 'Complications of Pregnancy, Childbirth and the Puerperium', 'Respiratory Diseases' and 'Injury and Poisoning' with an estimated 1,580 - 2,890 more hospital separations per 100,000 population per year compared to the Western population.

Age-standardized Average Length of Stay

The age-standardized Average Length of Stay for the First Nations population was similar to the age-standardized Average Length of Stay for the Western population. On average, First Nations spent 7 days in hospital compared to 6.6 days for the Western population. This small difference in Average Length of Stay may be attributed to the type and severity of the condition, distance from the hospital, and/or the restricted availability of other resources in the community (for example, rehabilitation and home care services). As previously stated, First Nations had higher hospital separation rates for all causes except 'Perinatal Conditions' and 'Congenital Anomalies'; thus, for selected diseases and injuries, if resources were not available within the community, the patient would have to stay in the hospital to receive additional care before returning to their community and home. It should be noted that the Average Length of Stay includes only the number of days a patient stays in the hospital. It does not include travel and/or time spent in a boarding home, or patients seen on an out-patient basis.

All Causes of Hospitalizations Excluding Complications of Pregnancy

With the exception of those under one year of age, the age-specific hospital separation rates (excluding complications of pregnancy) were higher for the First Nations population compared to the Western population (Figure 4). Within the First Nations population, infants less than one year of age had the highest hospital separation rate (98,000 hospital separations per 100,000 population). This rate was approximately 20% lower than the Western population separation rate (118,100 hospital separations per 100,000 population). After infants, First Nations seniors (aged 65 years and over) had the largest hospital separation rates, with age-specific separation rates ranging from two to three times higher than the corresponding Western population separation rates. The largest First Nations to Western population ratio was in the 55 to 59 year age category, with a First Nations separation rate three times higher than the Western population separation rate.

Figure 4. Age-specific Hospital Separation Rates for All Causes (Excluding Complications of Pregnancy), by Age Group, First Nations and General Population, Western Canada, 2000

Figure 4. Specific Hospital Separation Rates for All Causes (Excluding Complications of Pregnancy), by Age Group, First Nations and General Population, Western Canada, 2000

1. Ninety-eight First Nations separations with unknown age, twenty-seven Western population separations with unknown separation date, and seventeen Western population separations with unknown age were not included in the totals for the calculation of rates.
2. Includes on- and off-reserve populations from British Columbia, Saskatchewan and Manitoba only. Alberta was excluded from the analysis due to grouping differences.
3. Includes the provinces of British Columbia, Saskatchewan and Manitoba.

Notes:
a) Detailed rates can be found in Appendix 3.
b) All Causes (Excluding Complications of Pregnancy) refers to International Classification of Diseases, Version 9 codes 001-629, 680-999, V01-V82.
Source: British Columbia Ministry of Health, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Between the ages of one and 19 years, First Nations hospital separation rates were 50 to 100% higher than the Western population separation rates. After age 19, the First Nations hospital separation rates were even higher, with rates two to three times the Western population separation rates.

With the exception of those under one year of age, health services utilization by the First Nations population was highest in the 75 and over, 70 to 74, and 65 to 69 year age groups. Within these three age groups, First Nations experienced between 32,030 and 38,180 more hospital separations per 100,000 population compared to the Western population.

Injury and poisoning, and diabetes were major contributors to the considerable difference between the First Nations and the Western population hospital separation rates in the older age groups. For those under one year of age, the Western population separation rate was higher than the First Nations rate, largely due to the higher hospital separation rate observed for perinatal conditions.

Pregnancies, Childbirth and Puerperium with and without Complications

As shown in Figure 5, age-specific hospital separation rates for the First Nations female population were higher than those of the Western female population in all age groups from 15 to 44 years of age. The highest separation rate for First Nations women of childbearing age was seen in the 20 to 24 year age group (26,500 hospital separations per 100,000 population).

Figure 5. Age-specific Hospital Separation Rates for All Pregnancies, Childbirth and Puerperium, by Age Group, First Nations and General Population, Western Canada, 2000

Figure 5. Age-specific Hospital Separation Rates for All Pregnancies, Childbirth and Puerperium, by Age Group, First Nations and General Population, Western Canada, 2000

1. Only the female population was used in the rate calculation.
2. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba.
3. Includes the provinces of British Columbia, Alberta, Saskatchewan and Manitoba.

Notes:
a) Detailed rates can be found in Appendix 3.
b) All Pregnancies, Childbirth and Puerperium refers to International Classification of Diseases, Version 9 codes 630-676.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

The largest absolute rate difference between the First Nations population and the Western population was seen in the 20 to 24 year age group. The First Nations population had 17,550 more hospital separations per 100,000 population compared to the Western population.

Teenage pregnancies as well as pregnancies in women over the age of 35, greatly increase the risk of fetal complications such as low birth weight and prematurity.7 These complications increase the infant's risk of poor health and death. These infants are more likely to develop significant disabilities, and are more likely to have a longer period of hospitalization after birth.8

Chronic Diseases

In 2000, the First Nations hospital separation rates were higher than the Western population for each of the following chronic diseases: ischemic heart disease, cerebrovascular disease, diabetes and chronic obstructive pulmonary disease.

As shown in Figure 6, diabetes and ischemic heart disease had the highest age-standardized hospital separation rates among First Nations. The age-standardized separation rate for diabetes was seven times higher in the First Nations population than in the Western population (780 versus 110 hospital separations per 100,000 population), whereas the separation rate for ischemic heart disease was approximately two times higher. Chronic obstructive pulmonary disease and cerebrovascular disease separation rates in the First Nations population were two and a half and two times higher, respectively, than the corresponding Western population separation rates.

Figure 6. Age-standardized Hospital Separation Rates for Selected Chronic Conditions, First Nations and General Population, Western Canada, 2000

Figure 6. Age-standardized Hospital Separation Rates for Selected Chronic Conditions, First Nations and General Population, Western Canada, 2000

1. The 1991 populations for British Columbia, Alberta, Saskatchewan and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Fifty-two First Nations separations with unknown age, seven Western population separations with unknown separation date, and three general population separations with a discharge date of 2001 were not included in the totals for the calculation of rates.
3. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba.
4. Includes the provinces of British Columbia, Alberta, Saskatchewan and Manitoba.

Notes:
a) Detailed rates can be found in Appendix 3.
b) Ischemic heart disease refers to International Classification of Diseases, Version 9 codes 410-414.
c) Cerebrovascular refers to International Classification of Diseases, Version 9 codes 430-438.
d) Diabetes refers to International Classification of Diseases, Version 9 code 250.
e) COPD refers to International Classification of Diseases, Version 9 codes 490-493.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Diabetes and chronic obstructive pulmonary disease were the top two causes adding to the burden of First Nations health, with 670 and 390 more hospital separations per 100,000 population, respectively, compared to the Western population.

Ischemic heart disease is a major cause of illness, disability and death in Canada. The prevalence of risk factors such as smoking, obesity and diabetes in the First Nations population are higher than in the Western population.9 The overall age-standardized hospital separation rate for ischemic heart disease in the First Nations population was two times higher than the Western population separation rate. Modifying the risk behaviours listed previously may help to prevent not only circulatory diseases such as heart disease, but also many other chronic diseases that share the same risk factors.

A more detailed examination of chronic obstructive pulmonary disease shows that the highest age-specific separation rates for asthma and bronchitis were seen in the youngest (less than 10 years) and the oldest (65 years and over) age groups for both the First Nations and the Western population (Figure 7). However, in each age group (excluding the 10 to 19 year age group for asthma), the hospital separation rates were higher in the First Nations population than in the Western population. In the First Nations population, the highest hospital separation rate for asthma was seen in the less than one year age group with a separation rate of 1,840 hospital separations per 100,000 population, three times higher than its corresponding Western population separation rate. However, the highest hospital separation rate for bronchitis in the First Nations population was seen in the 65 years and over age group with a separation rate of 1,230 hospital separations per 100,000 population, also three times higher than the corresponding Western population separation rate. Despite the 65 years and over age group having the highest hospital separation rate and largest absolute difference between rates (820 more hospital separations per 100,000 population for First Nations population compared to the Western population) for bronchitis, the largest First Nations to Western population ratio was seen in the less than one year age group with the First Nations separation rate being seven times higher than the Western population separation rate (680 versus 100 hospital separations per 100,000 population).

Figure 7. Age-specific Hospital Separation Rates for Asthma and Bronchitis, First Nations and General Population, Western Canada, 2000

Figure 7. Age-specific Hospital Separation Rates for Asthma and Bronchitis, First Nations and General Population, Western Canada, 2000

1. Two Western population separations with unknown age were not included in the totals for the calculation of rates.
2. Includes on- and off-reserve populations from British Columbia, Alberta (asthma only), Saskatchewan and Manitoba.
3. Includes the provinces of British Columbia, Alberta (asthma only), Saskatchewan and Manitoba.

Notes:
a) Detailed rates can be found in Appendix 3.
b) Asthma refers to International Classification of Diseases, Version 9 code 493.
c) Bronchitis refers to International Classification of Diseases, Version 9 codes 491-492.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Next to 'Complications of Pregnancy, Childbirth and the Puerperium', the second most common cause of hospital separation rates for First Nations in 2000 was 'Respiratory Diseases' (Figure 3). As with heart disease, risk factors for respiratory diseases are more prevalent in the First Nations population than in the Western population. Risk factors for respiratory diseases include smoking, both active personal smoking and passive (second-hand) exposure to environmental tobacco smoke, indoor and outdoor air quality, and the presence of in-house mould. It has been estimated that approximately three-quarters of chronic obstructive pulmonary disease mortality in Canada, and other high-income countries, is associated with cigarette smoking.10,11 Additionally, smoking also increases an individual's risk of developing other diseases and adverse health effects.12 For individuals with chronic obstructive pulmonary disease and asthma, exposure to environmental tobacco smoke can make symptoms worse.13 Those who reduce or quit smoking may greatly reduce their risk of developing respiratory diseases.13

The presence of in-house mould, which has been identified as a problem in many First Nations communities, may also increase the risk for respiratory diseases.14 Inadequate housing (housing with circulation and moisture issues) can lead to mould growth, which in turn can lead to a number of health problems, including allergic complications such as asthma attacks, non-allergic reactions such as headaches, as well as coughing and wheezing.15

Cancer

The age-standardized hospital separation rates for cancerous and non-cancerous neoplasms were identical in the First Nations and Western populations (590 hospital separations per 100,000 population). In examining selected cancers, the First Nations hospital separation rates were found to be higher than the Western population separation rates for lung cancer, colorectal cancer, and cervical cancer (Figure 8). Female breast cancer and prostate cancer were 10 to 20% higher in the Western population.

Figure 8. Age-standardized Hospital Separation Rates for Selected Cancers, First Nations and General Population, Western Canada, 2000

Figure 8. Age-standardized Hospital Separation Rates for Selected Cancers, First Nations and General Population, Western Canada, 2000

1. The 1991 populations for British Columbia, Saskatchewan, and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Includes on- and off-reserve populations from British Columbia, Saskatchewan and Manitoba only. Alberta was excluded from the analysis due to grouping differences.
3. Includes the provinces of British Columbia, Saskatchewan and Manitoba.

Notes: a) Detailed rates can be found in Appendix 3.
b) For Female breast cancer and Cervical cancer, only the female population was used in the rate calculation.
c) For Prostate cancer, only the male population was used in the rate calculation.
d) Lung cancer refers International Classification of Diseases, Version 9 code 162.
e) Female breast cancer refers to International Classification of Diseases, Version 9 code 174.
f) Prostate cancer refers to International Classification of Diseases, Version 9 code 185.
g) Colorectal cancer refers to International Classification of Diseases, Version 9 codes 153-154.
h) Cervical cancer refers to International Classification of Diseases, Version 9 code 180.
Source: British Columbia Ministry of Health, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

The hospital separation rate for cervical cancer was three times higher in the First Nations population than in the Western population. Cervical cancer also had the largest absolute rate difference with First Nations experiencing 20 more hospital separations per 100,000 population compared to the Western population. Nearly all (70%) cervical cancers are caused by persistent high-risk human papillomavirus infection.16 Access to cervical screening services, human papillomavirus vaccination programs and education programs targeting safe sexual health practices may assist in the prevention and early detection of cervical cancer.

The overall age-standardized rate of hospital separations for cancer in the First Nations population was similar to the separation rate in the Western population. In Canada, it has been estimated that a large proportion of fatal cancers are associated with the use of tobacco and poor diet.17 Other factors, including socio-economic status and environmental pollution, are also thought to be causes of cancers.18

Diabetes

The age-specific hospital separation rates for diabetes increased with age for both the First Nations and Western populations (Figure 9). The increase for First Nations, however, was at a greater rate. When comparing the age-specific hospital separation rates for diabetes between First Nations males and females, similar rates were observed in the younger age groups (less than 20 years of age until the 30 to 34 year age group). However, starting from the 35 to 39 year age group and ending in the 50 to 54 year age group, First Nations males had consistently higher hospital separation rates. This observed trend was reversed in the older age groups (55 years and older), with First Nations females exhibiting higher hospital separation rates for diabetes.

Figure 9. Age-specific Hospital Separation Rates for Diabetes, by Sex and Age Group, First Nations and General Population, Western Canada, 2000

Figure 9. Age-specific Hospital Separation Rates for Diabetes, by Sex and Age Group, First Nations and General Population, Western Canada, 2000

1. Sixteen First Nations separations with unknown age were not included in the totals for the calculation of rates.
2. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba.
3. Includes the provinces of British Columbia, Alberta, Saskatchewan and Manitoba.

Notes:
a) Detailed rates can be found in Appendix 3.
b) Diabetes refers to International Classification of Diseases, Version 9 code 250.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Expressed as ratios, the largest ratio in age-specific separation rates between First Nations males and females was seen in the 35 to 39 year age group. Within this age group, the First Nations male separation rate was two times higher than the First Nations female separation rate (380 versus 190 hospital separations per 100,000 population). In terms of additional burden on health, the largest absolute difference in separation rates was seen in the 70 years and over age group where First Nations females experienced 1,390 more hospital separations per 100,000 population compared to First Nations males.

For both sexes in the First Nations and Western populations, the highest hospital separation rates for diabetes were found in the 70 years and over age group. The largest First Nations to Western population ratio was seen in the 50 to 54 year age group for males with a First Nations separation rate approximately 10 times higher than the Western population separation rate (1,570 versus 150 hospital separations per 100,000 population). For females, the largest First Nations to Western population ratio was seen in the 55 to 59 year age group with a First Nations separation rate 15 times higher than the Western population separation rate (2,760 versus 180 hospital separations per 100,000 population).

As with the differences between First Nations males and females, the largest absolute rate difference was seen between First Nations and the Western population males and females in the 70 years and over age group. First Nations males experienced 2,350 more hospital separations per 100,000 population compared to the Western male population, and First Nations females experienced 3,860 more hospital separations per 100,000 population compared to the Western female population.

Starting at 40 years of age, First Nations females had an eight to 15 times higher rate of hospital separations for diabetes than the Western female population. First Nations males had a six to 10 times higher rate of hospital separations for diabetes than the Western male population starting at 40 years of age.

Diabetes is a major health issue for the Aboriginal (First Nations, Inuit and Métis) population. Modifiable risk factors such as sedentary lifestyle and dietary habits, both of which have an impact on obesity, are significant in the prevention of diabetes. Other concerns related to diabetes in the Aboriginal population include early disease onset, greater severity at diagnosis, high rates of complications (for example, heart disease, stroke, lower limb amputations), lack of accessible services, and increasing prevalence of diabetes and its associated risk factors.19 Based on these concerns, increases in access to services and education programs could aid in the early detection, treatment and control of diabetes, which are essential to reduce the personal and public health burden of diabetes in First Nations communities.20

Communicable Diseases

Upon examination of specific communicable diseases, namely pneumonia and influenza, separation rates for both communicable diseases were higher in the First Nations population than in the Western population. The First Nations age-standardized hospital separation rate for pneumonia was more than four times higher than the Western population separation rate (1,330 versus 300 hospital separations per 100,000 population). Similarly, the separation rate for influenza among the First Nations population was four times higher than the separation rate in the Western population (70 versus 20 hospital separations per 100,000 population) (Figure 10).

Figure 10. Age-standardized Hospital Separation Rates for Selected Communicable Diseases, First Nations and General Population, Western Canada, 2000

Figure 10. Age-standardized Hospital Separation Rates for Selected Communicable Diseases, First Nations and General Population, Western Canada, 2000

1. The 1991 populations for British Columbia, Alberta (pneumonia only), Saskatchewan and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Includes on- and off-reserve populations from British Columbia, Alberta (pneumonia only), Saskatchewan and Manitoba.
3. Includes the provinces of British Columbia, Alberta (pneumonia only), Saskatchewan and Manitoba.

Notes:
a) Detailed rates can be found in Appendix 3.
b) Pneumonia disease refers to International Classification of Diseases, Version 9 codes 480-486.
c) Influenza disease refers to International Classification of Diseases, Version 9 code 487.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

In terms of the burden on health, First Nations had 1,030 more hospital separations per 100,000 population compared to the Western population for pneumonia and 60 more hospital separations per 100,000 population compared to the Western population for influenza.

Influenza is an acute respiratory illness, with the most common complication being pneumonia. The hospital separation rates for influenza and pneumonia were higher in the First Nations population than in the Western population. Reasons for these higher separation rates may include the higher rates of heart and respiratory diseases in the First Nations population since individuals with these diseases have an increased risk of contracting influenza and pneumonia.21 Over-crowded housing conditions may increase the risk of contracting influenza and pneumonia. If just one individual develops influenza, there is an increased risk that other family members living in the house will also catch the virus. Increased up-take of the influenza vaccine, especially amongst the young, the elderly, and those with heart and respiratory conditions, may help reduce the spread of influenza.21

Injury and Poisoning

Injury is a leading cause of death among First Nations people.22 As well, injury tends to kill people at comparatively young ages, making it by far the leading cause of Potential Years of Life Lost. This topic will be discussed in a forthcoming report from this series. Aside from fatal injuries, however, there are many non-fatal ones that result in hospitalizations, emergency department or general practitioner treatment, or treatment at home/school/work.23 Information on these injuries is not always reported or available, resulting in a potential misrepresentation of the true incidence of injuries. The injury pyramid shown in Figure 11 helps to illustrate this fact.23

Figure 11. Injury Pyramid

Figure 11. Injury Pyramid

Source: Espitia-Hardeman V, Paulozzi L. Injury Surveillance Training Manual. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2005.

Hospital separation data for reported injuries and poisonings can be analyzed in several ways, such as at the International Classification of Diseases, Version 9 chapter level, or through the use of Nature of Injury diagnosis codes or External Causes of Injury codes. Nature of Injury codes broadly indicate the type of injury such as a fracture or burn, while External Causes of Injury codes categorize the presented by intent (mechanism and intent of injury. External Causes of Injury codes consist of a comprehensive range of injury categories which include intentional and unintentional injuries as well as injuries of unknown intent.

This report presents data at the International Classification of Diseases, Version 9 chapter level (by population, sex and age), and further by External Causes of Injury codes, which are deemed to be more relevant to health promotion and injury prevention. External Causes of Injury codes data are intentional or unintentional injury), and then by mechanism of injury. (See list of injury groupings in Appendix 1.)

At the chapter level, based on age-standardized separation rates, 'Injury and Poisoning' was the fourth leading cause of all hospital separations in the First Nations population, and approximately three times higher than the corresponding Western population separation rate (2,540 versus 960 hospital separations per 100,000 population). When examining the crude separation rates, 'Injury and Poisoning' was the third leading cause of all hospital separations in the First Nations population. By age-standardizing the First Nations population so that it has the same age distribution as the Western population, 'Injury and Poisoning' loses some prominence among other causes of hospitalizations, but still represents a significant portion of health care utilization by First Nations.

For all age groups, age-specific hospital separation rates were higher in the First Nations population than in the Western population (Figure 12). The highest rate of hospital separations for First Nations males was seen in the 70 to 74 year age group with an age-specific separation rate of 4,840 hospital separations per 100,000 population, whereas for the Western male population, the highest separation rate was in the 75 years and over age group with an age-specific separation rate of 2,980 hospital separations per 100,000 population. The highest rates of hospital separations for First Nations females and the general Western female population were seen in the 75 years and over age group with age-specific separation rates of 7,410 hospital separations per 100,000 population for First Nations females and 3,970 hospital separations per 100,000 population for the general Western female population.

Figure 12. Age-specific Hospital Separation Rates for All Injuries and Poisonings, by Sex and Age Group, First Nations and General Population, Western Canada, 2000

Figure 12. Age-specific Hospital Separation Rates for All Injuries and Poisonings, by Sex and Age Group, First Nations and General Population, Western Canada, 2000

1. One Western population separation with unknown sex, and five Western population separations with unknown separation date were not included in the totals for the calculation of rates.
2. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba.
3. Includes the provinces of British Columbia, Alberta, Saskatchewan and Manitoba.

Notes:
a) Detailed rates can be found in Appendix 3.
b) All Injuries and Poisonings refers to International Classification of Diseases, Version 9 codes 800-999.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

When comparing the age-specific hospital separation rates for all injuries and poisonings between First Nations males and females, First Nations males had consistently higher hospital separation rates, starting in the less than one year age group until the 50 to 54 year age group. This observed trend was reversed in the older age groups (55 years and older), with First Nations females exhibiting higher hospital separation rates for all injuries and poisonings, with the exception of the 70 to 74 year age group.

The largest First Nations male to female ratio was observed in both the under one year, and the 20 to 24 year age groups, in which males had twice as many hospital separations than females. In terms of additional burden on health, the largest difference between First Nations males and females was seen in the 75 years and over age group where First Nations females experienced 3,290 more hospital separations per 100,000 population compared to First Nations males.

The largest ratio in age-specific separation rates between the First Nations population and the Western population was seen in the 30 to 34 year age group for males, with a First Nations separation rate three times higher than the Western population separation rate (3,150 versus 980 hospital separations per 100,000 population). For females the largest ratio in age-specific separation rates was seen in the 25 to 29 year age group, with a First Nations separation rate four times higher than the Western population separation rate (2,310 versus 550 hospital separations per 100,000 population). The largest absolute rate difference seen between First Nations males and the Western male population was in the 70 to 74 year age group. First Nations males experienced 3,060 more hospital separations per 100,000 population compared to the Western male population. For females, the largest absolute rate difference was seen in the 75 years and over age group with First Nations females experiencing 3,440 more hospital separations per 100,000 population compared to the Western female population. The next largest absolute rate difference between First Nations and the Western population, for both males and females was seen in the 65 to 69 year age group.

External Causes of Injury

As previously mentioned, using External Causes of Injury code data, injuries have been categorized into two groups:

  • Intentional injuries: include self-inflicted injuries (suicide or self-harm) and those inflicted by someone else (homicide or assault).
  • Unintentional injuries: are those for which there is no intent to harm (for example, falls, motor vehicle collisions).

The First Nations population had a hospital separation rate for unintentional injuries that was four times higher than the Western population separation rate, and the hospital separation rate of intentional injuries was five times higher than the Western population separation rate (as demonstrated in Figure 13). Although the First Nations to Western population ratio for intentional injuries was higher than for unintentional injuries, the absolute rate difference between the First Nations population and the Western population for unintentional injuries was higher than the difference for intentional injuries. First Nations experienced 2,650 more hospital separations per 100,000 population for unintentional injuries compared to the Western population. In terms of intentional injuries, First Nations experienced 570 more hospital separations per 100,000 population compared to the Western population.

Figure 13. Age-standardized Hospital Separation Rates for Intentional and Unintentional Injuries, First Nations and General Population, Western Canada, 2000

Figure 13. Age-standardized Hospital Separation Rates for Intentional and Unintentional Injuries, First Nations and General Population, Western Canada, 2000

1. The 1991 populations for British Columbia, Saskatchewan, and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Includes on- and off-reserve populations from British Columbia, Saskatchewan and Manitoba only. Alberta was excluded from the analysis due to grouping differences.
3. Includes the provinces of British Columbia, Saskatchewan and Manitoba.

Notes:
a) Detailed rates can be found in Appendix 3.
b) Intentional injuries refers to International Classification of Diseases, Version 9 codes E950-E958, E960-E968.
c) Unintentional injuries refers to International Classification of Diseases, Version 9 codes E800-E848, E850-E869, E880-E886, E888, E890-E928.
Source: British Columbia Ministry of Health, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

External Causes of Injury codes data were further categorized into 14 groupings based on the mechanism of the injury (see Appendix 1 for a detailed listing of groups). As shown in Figure 14, the hospital separation rate for injuries in the First Nations male population was higher than the female population for half of the selected injury categories (separation rates are found in Table 12 in Appendix 3). These categories include:

  • Motor/road vehicle collisions
  • Other transport
  • Fire/flames
  • Environmental
  • Drowning/suffocation
  • Assault
  • Other

The leading cause of hospital separations among First Nations males, excluding other and undetermined categories, was falls with a rate of 510 hospital separations per 100,000 population. This was followed by assault, motor/road vehicle collisions and surgical complications, with hospital separation rates of 480, 320 and 260 per 100,000 population, respectively.

Figure 14. Crude Hospital Separation Rates for Selected Injuries, by Sex, First Nations, Western Canada, 2000

Figure 14. Crude Hospital Separation Rates for Selected Injuries, by Sex, First Nations, Western Canada, 2000

1. Includes on- and off-reserve populations from British Columbia, Saskatchewan and Manitoba only. Alberta was excluded from the analysis due to grouping differences.

Notes:
a) Detailed rates can be found in Appendix 3.
b) Motor/road vehicle refers to International Classification of Diseases, Version 9 codes E810-E825.
c) Other transport refers to International Classification of Diseases, Version 9 codes E800-E807, E826-E838, E840-E848.
d) Poisonings refers to International Classification of Diseases, Version 9 codes E850-E858, E860-E869.
e) Misadventures refers to International Classification of Diseases, Version 9 codes E870-E876.
f) Surgical complications refers to International Classification of Diseases, Version 9 codes E878-E879.
g) Falls refers to International Classification of Diseases, Version 9 codes E880-886, E888.
h) Fire/flames refers to International Classification of Diseases, Version 9 codes E890-E899.
i) Environmental refers to International Classification of Diseases, Version 9 codes E900-E909.
j) Drowning/suffocation refers to International Classification of Diseases, Version 9 codes E910-E915.
k) Adverse effects refers to International Classification of Diseases, Version 9 codes E930-E949.
l) Suicide/self-injury refers to International Classification of Diseases, Version 9 codes E950-E958.
m) Assault refers to International Classification of Diseases, Version 9 codes E960-E968.
n) Other refers to International Classification of Diseases, Version 9 codes E887, E916-929, E959, E969-978, E989-E999.
o) Undetermined refers to International Classification of Diseases, Version 9 codes E980-E988.
Source: British Columbia Ministry of Health, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Among First Nations females, falls were the leading cause of hospital separations with a rate of 560 hospital separations per 100,000 population. This was followed by suicide/self-injury, surgical complications and motor/road vehicle collisions, with hospital separation rates of 470, 380, and 250 per 100,000 population, respectively, excluding the other category.

The largest male to female ratio in the First Nations population was for the fire/flame category, where the First Nations male hospital separation rate was seven and a half times higher than the female separation rate. However, the largest difference between the First Nations male and female populations, excluding the other category was observed in the assault category where First Nations males experienced 290 more hospital separations per 100,000 population compared to the First Nations female population. Following assault, suicide/self-injury and surgical complications had the second and third largest hospital separation rate differences between First Nations males and females, with females experiencing higher hospital separation rates.

The four largest age-standardized hospital separation rates due to injuries among First Nations were falls, surgical complications, suicide/self-injury and motor/road vehicle collisions (Figure 15). The hospital separation rate for falls was two times higher than the corresponding Western population separation rate, suicide/self-injury was four times higher and motor/road vehicle collisions were two times higher than their corresponding Western population separation rates.

Figure 15. Age-standardized Hospital Separation Rates for Selected Injuries, First Nations and General Population, Western Canada, 2000

Figure 15. Age-standardized Hospital Separation Rates for Selected Injuries, First Nations and General Population, Western Canada, 2000

1. The 1991 populations for British Columbia, Saskatchewan and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Includes on- and off-reserve populations from British Columbia, Saskatchewan and Manitoba only. Alberta was excluded from the analysis due to grouping differences.
3. Includes the provinces of British Columbia, Saskatchewan and Manitoba.

Notes:
a) Detailed rates can be found in Appendix 3.
b) Motor/road vehicle refers to International Classification of Diseases, Version 9 codes E810-E825.
c) Other transport refers to International Classification of Diseases, Version 9 codes E800-E807, E826-E838, E840-E848.
d) Poisonings refers to International Classification of Diseases, Version 9 codes E850-E858, E860-E869.
e) Misadventures refers to International Classification of Diseases, Version 9 codes E870-E876.
f) Surgical complications refers to International Classification of Diseases, Version 9 codes E878-E879.
g) Falls refers to International Classification of Diseases, Version 9 codes E880-886, E888.
h) Fire/flames refers to International Classification of Diseases, Version 9 codes E890-E899.
i) Environmental refers to International Classification of Diseases, Version 9 codes E900-E909.
j) Drowning/suffocation refers to International Classification of Diseases, Version 9 codes E910-E915.
k) Adverse effects refers to International Classification of Diseases, Version 9 codes E930-E949.
l) Suicide/self-injury refers to International Classification of Diseases, Version 9 codes E950-E958.
m) Assault refers to International Classification of Diseases, Version 9 codes E960-E968.
Source: British Columbia Ministry of Health, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

The age-standardized hospital separation rate for all injuries in the First Nations population was higher than the equivalent rate in the Western population (separation rates can be found in Table 13 in Appendix 3). The largest First Nations to Western population ratio was seen in the assault category, where the First Nations hospital separation rate was six times higher than the Western population separation rate. The largest difference between the First Nations population and the Western population was seen in the falls category. First Nations experienced 470 more hospital separations per 100,000 population compared to the Western population. Following falls, suicide/self-injury and assault had the second and third largest absolute rate differences between the First Nations population and the Western population.

Injuries are a serious public health problem in Canada, and even more so in the First Nations population. Injuries occurring in the First Nations population tend to follow a similar pattern to that found in the Western population, but at much higher rates. Possible reasons for higher injury hospital separation rates among the First Nations population are their often isolated residences, their physical environment, crowded and dilapidated housing conditions, lifestyle, and poor social and economic conditions.22 Other factors that contribute to an increased risk of sustaining an injury include: being a young adult, being male, and individuals who are suffering from depression and/or substance abuse.20 Preventing injuries is likely to require action at several levels: attacking the root causes (for example, reducing social inequities, strengthening families); modifying the environment or equipment use (for example, increased seatbelt use); and introducing programs to modify lifestyles (for example, education on risks, treatment for substance abuse).20

It is important to keep in mind that in-patient hospitalization data provide only one part of the picture regarding injuries, as no data have been provided on emergency visits, out-patient treatment or from nursing stations. The number of emergency visits is thought to greatly exceed hospital admissions; one estimate places emergency visits at almost 30 times greater than hospital admissions.24

Conclusion

The data presented in this report represent only four First Nations and Inuit Health Branch regions: British Columbia, Alberta, Saskatchewan and Manitoba, accounting for 60% of the total Canadian First Nations population. It is therefore important to keep in mind that:

  1. the data do not provide full coverage of all First Nations in Canada so utilization rates may not be representative of all First Nations in Canada;
  2. adjustments were made to the data for the purposes of comparisons, the remaining error in generalizing to the Indian and Northern Affairs Canada population is unpredictable; and
  3. the hospital separation data from Alberta originate from a database developed specifically for another project and not the complete provincial hospital administrative database.

The results in this report should be interpreted with caution. As a result of these limitations, there is a need to improve national data; particularly to identify First Nations in hospital data, or at least to access First Nations hospital data that already exist in administrative databases.

Hospital utilization data provide some insight into the health of a population, but cannot provide accurate estimates of the prevalence of a disease or disorder within that population. Hospital separations are limited to information about the reasons for which people are hospitalized and the procedures they undergo in hospital and do not include information on those who access other health services, such as general practitioners, community health clinics and out-patient hospital services, or those who have not accessed health care at all.25

Hospital separation data are affected by many factors other than health status. Factors such as proximity of the service, and availability of, and access to, other medical services may influence hospital utilization, as may social factors relating to culture, socioeconomic status of patients, and transport availability. This is particularly true for remote and isolated communities. In addition, language and transportation barriers may contribute to overall hospital separation rates. Consequently the data reported do not necessarily describe actual levels of need or ill health in the First Nations and Canadian populations. A high rate of hospital separations, for example, could mean that health status is deteriorating or that access to hospitals has improved.26 Regardless, the information presented here indicates higher rates of health care utilization by First Nations than the Western population.

References

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(11) Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, editors. Global burden of disease and risk factors. New York: Oxford University Press and The World Bank; 2006.

(12) U.S. Department of Health and Human Services. The health consequences of smoking: A report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.

(13) Canadian Institute for Health Information, Canadian Lung Association, Health Canada, Statistics Canada. Respiratory disease in Canada. Ottawa: Respiratory Disease in Canada Editorial Board, Health Canada; 2001. Catalogue number H39-593/2001E.

(14) Boles B (Canadian Mortgage and Housing Corporation). A study of recurring mold problems on the Roseau River Reserve, Manitoba. Ottawa: CMHC; 1998. Research Highlights Technical Series 99-101.

(15) Health Canada. Dampness, mould and indoor air. Ottawa: Health Canada; 2007. Available from: http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/environ/air-eng.php

(16) Canadian Cancer Society. Human papillomavirus. Canada: Canadian Cancer Society; 2008. Available from: http://www.cancer.ca/Canada-wide/Prevention/Other%20risk%20factors/Human%20papillomavirus%20HPV.aspx?sc_lang=en

(17) Health Canada. Diseases and conditions - Cancer. Ottawa: Health Canada; 2008. Available from: URL: http://www.hc-sc.gc.ca/dc-ma/cancer/index-eng.php

(18) The Harvard Report on Cancer Prevention, Volume 1: Causes of Human Cancer. Cancer Causes & Control 1996; 7 Suppl. 1: s3-s9.

(19) Health Canada. Diabetes among Aboriginal people (First Nations, Inuit and Métis) in Canada: The evidence. Ottawa; 2001. Catalogue number H35-4/6-2001E.

(20) First Nations Information Governance Committee. First Nations Regional Longitudinal Health Survey (RHS) 2002-03; Results for adults, youth and children living in First Nations communities. Assembly of First Nations; November 2005.

(21) National Advisory Committee on Immunization. National Advisory Committee on Immunization: Statement on influenza vaccination for the 2007-2008 season. Canada Communicable Diseases Report 2007; 33(ACS-7):1-38.

(22) Health Canada. Unintentional and intentional injury profile for Aboriginal people in Canada. Ottawa: Public Works and Government Services Canada; 2001. Catalogue number H35-4/8-1999.

(23) Espitia-Hardeman V, Paulozzi L. Injury surveillance training manual. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2005.

(24) Whitehead S, Henning B, Johnston J, Devlin A. Developing an injury morbidity and mortality profile in the Sioux Lookout Zone: 1992-1995. Ottawa: Public Works and Government Services Canada; 1996.

(25) Australian Institute of Health and Welfare and Australian Bureau of Statistics. Hospital Statistics: Aboriginal and Torres Strait Islander Peoples: 1999-2000. Australia: Australian Bureau of Statistics; 2002. Catalogue number IHW 9.

(26) Australian Institute of Health and Welfare and Australian Bureau of Statistics. The health and welfare of Australia's Aboriginal and Torres Straight Islander Peoples, 2005. Australia: ABS & AIHW; 2005. Catalogue number IHW14.

Glossary

Age-Specific Rate: The number of cases per 100,000 persons per year for a specific, narrow age range. Five-year age groups are commonly used.

Age-Standardized Rate: A statistical method that allows comparisons of groups of people from different backgrounds and age structures.

Average Length of Stay: Average length of stay in hospitals is calculated by taking the total number of days spent in hospitals and dividing it by the number of hospital separations.

Bill C-31: Bill C-31 is the pre-legislation name of a 1985 amendment to the Indian Act. The amendment was designed to eliminate several discriminatory provisions from the Indian Act concerning the unjust removal of First Nations people from the Indian Register, such as the removal of a First Nations woman and her children if she were to marry a non-Indian. The major impact of Bill C-31 has been the restoration of Indian status to people who lost it under the Act's unjust provisions. Approximately 105,000 people have regained or acquired Indian Status since the passage of the bill in 1985. For further information please visit the Next link will take you to another Web site Indian and Northern Affairs Canada website.

Crude Rate: The rate of incidence of an event or quality in an entire population.

Determinant: Any factor, whether event, characteristic, or other definable entity, that brings about a change in a health condition or other defined characteristic.1

Difference: The value obtained by subtracting one quantity by another.

External Causes of Injury: The World Health Organization's manual of the international classifications of diseases, injuries and causes of death includes a separate classification of external causes of injury and poisoning. External Causes of Injury codes categorize the mechanism and intent of injury and consist of a broad range of injury categories which include intentional and unintentional injuries as well as injuries of unknown intent.

First Nation: A term that came into common usage in the 1970s to replace the word 'Indian' which many people found offensive. Although the term 'First Nation' is widely used, no legal definition of it exists. Many Indian people have also adopted the term 'First Nation' to replace the word 'Band' in the name of their community. Both Status and non-Status Indian people in Canada are referred to as 'First Nations people(s)'. In the Canadian Census of Population, 'North American Indian' is the term used for this population.

Health Status: An overall evaluation of the health of an individual, with many indicators such as quality of life and functionality contributing to the assessment.

Hospital Separation: People who leave hospitals through a completed procedure, discharge or death. The number of hospital separations is often used to examine the trends in morbidity of a disease. In this context, hospital separations do not include any out-patient procedures.

Indian: Indian is a term that describes all Aboriginal people in Canada who are neither Inuit nor Métis. Indian peoples are one of three groups recognized as Aboriginal in the Constitution Act of 1982. The Act specifies that Aboriginal people in Canada comprise Indians, Inuit and Métis people. In addition, there are three legal definitions that apply to Indians in Canada: Status Indians, non-Status Indians and Treaty Indians. In the Canadian Census of Population, 'North American Indian' is the term used for this population.

In-Patient Care: Treatment received as a bed-patient in a hospital, a skilled nursing facility, a rehabilitation hospital, or a substance abuse treatment facility, usually for a period of more than 24 hours.

International Classification of Diseases, Version 9: The World Health Organization's manual of the international classifications of diseases, injuries and causes of death. It is the international standard for determining the cause of mortality and morbidity, and is used in this report. In addition to the classification of different diseases, there is a separate classification of external causes of injury and poisoning.

Inuit: Aboriginal people in northern Canada who live above the tree line in Nunavut, the Northwest Territories, northern Quebec and Labrador. The word means 'people' in Inuktitut, the Inuit language. The singular of Inuit is Inuk.

Non-Status Indian: The Indian Act defines a non-Status Indian as an Indian person who is not registered under the Indian Act. This may be because his or her ancestors were never registered, or because he or she lost Indian status under former provisions of the Indian Act.

Off-Reserve: A term used to describe people, services or objects that are not part of a reserve but that relate to a First Nation.

On-Reserve: A term used to describe First Nations people that live on a reserve, land set aside by the Federal Government for the use and occupancy of an Indian group or band.

Out-Patient: A patient who does not require hospitalization and is not a bed-patient is referred to as an out-patient. Treatment can be ongoing or short-term.

Population: People who inhabit a territory, state, country, province or otherwise defined geographic area.

Primary Diagnosis: The main condition treated or investigated during the relevant episode of health care is referred to as primary diagnosis.

Rate: The proportion of a group affected over a period of time such as a year. It is usually expressed as cases (or deaths, separations, etcetera) per 100,000 population per year.

Rate Ratio: The rate ratio is obtained by dividing the quantity of one rate by another rate. Ratios are relative comparisons; for example dividing the age-standardized hospital separation rate of the First Nations population by the age-standardized hospital separation rate of the Western population. A rate ratio of 1.0 indicates that First Nations people are more likely to be hospitalized, while a rate ratio less than 1.0 indicates that First Nations people are less likely to be hospitalized compared to the Western population.

Ratio: The value obtained by dividing one quantity by another; a general term of which rate, proportion, percentage, etcetera, are subsets.1

Region: Defined as a First Nations and Inuit Health Branch administrative area that in most cases corresponds to a province. Newfoundland and Labrador, Nova Scotia, New Brunswick and Prince Edward Island are often grouped as the Atlantic Region. Similarly, the Yukon, the Northwest Territories and Nunavut are grouped under the Northern Region (formerly the Northern Secretariat). British Columbia has historically been referred to as the Pacific Region.

Registered Indian: See Status Indian.

Reserve: Land set aside by the Federal Government for the use and occupancy of an Indian group or band.

Risk Difference: The risk difference is obtained by subtracting the quantity of one rate from the quantity of another rate. Differences are absolute comparisons; for example subtracting the age-standardized separation rate for the Western population from the age-standardized separation rate for the First Nations population. A positive rate difference indicates the excess separation rate in the First Nations population.

Risk Factor: A risk factor is a factor associated with an increased chance of getting a disease; it may be a cause or simply a risk marker. Factors associated with decreased risk are known as protective factors.

Socio-Economic Status: Refers to a person or group's position within a social hierarchy. Socio-economic status is determined by such indicators as education, income, occupation, wealth and place of residence, among others.

Status (Registered) Indian: A Status (Registered) Indian is an Indian person who is registered under the Indian Act. The act sets out requirements for determining who is a Status Indian.

1. Last JM. A dictionary of epidemiology. 4th ed. New York: Oxford University Press; 2001.

Appendix 1: International Classification of Diseases, Version 9 Chapters and Codes

The three-part table below provides code groupings for International Classification of Diseases, Version 9 chapters, external causes of injury and poisoning, and frequently tabulated medical conditions, to be used as a guide when reading this report.

Code groupings for International Classification of Diseases, Version 9 chapters, external causes of injury and poisoning, and frequently tabulated medical conditions, to be used as a guide when reading this report.
International Classification of Diseases, Version 9 Chapter International Classification of Diseases, Version 9 Chapter Title (Note: When space is limited in the report, the text in parenthesis is used) International Classification of Diseases, Version 9 Codes
1 Infectious and Parasitic Diseases (Infectious and Parasitic) 001-139
2 Cancerous and Non-cancerous Neoplasms 140-239
3 Endocrine, Nutritional and Metabolic Diseases and Immunity Disorders (Endocrine and Immune) 240-279
4 Diseases of Blood and Blood-forming Organs (Blood Diseases) 280-289
5 Mental Disorders 290-319
6 Diseases of the Nervous System and Sense Organs (Nervous System) 320-389
7 Diseases of the Circulatory System (Circulatory Diseases) 390-459
8 Diseases of the Respiratory System (Respiratory Diseases) 460-519
9 Diseases of the Digestive System (Digestive Diseases) 520-579
10 Diseases of the Genitourinary System (Genitourinary Diseases) 580-629
11 Complications of Pregnancy, Childbirth and the Puerperium 630-676
12 Diseases of the Skin and Subcutaneous Tissue (Skin Diseases) 680-709
13 Diseases of the Musculoskeletal System and Connective Tissue (Musculoskeletal) 710-739
14 Congenital Anomalies 740-759
15 Certain Conditions Originating in the Perinatal Period (Perinatal Conditions) 760-779
16 Symptoms, Signs and Ill-defined Conditions (Symptoms and Ill-defined Conditions) 780-799
17 Injury and Poisoning 800-999
Supplementary Factors Influencing Health Status and Contact with Health Services (this includes when a person who is not currently sick encounters the health services for some specific purpose or when some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury). (Factors Influencing Health Status and Contact with Health Services) V01-V19
Supplementary External Causes of Injury and Poisoning E800-E999

External Cause (E-Code) of Injury and Poisoning Major Groupings

Groupings used in report (Note: When space is limited in the report, the text in parenthesis is used) International Classification of Diseases, Version 9  Groupings E-Codes
Motor/road vehicle collisions (Motor/road vehicle) Motor vehicle traffic accidents E810-E819
Motor/road vehicle collisions (Motor/road vehicle) Motor vehicle non-traffic accidents E820-E825
Other transport Railway accidents
Other road vehicle accidents
Water transport accidents
Air and space transport accidents
Vehicle accidents not elsewhere classifiable
E800-E807
E826-E829
E830-E838
E840-E845
E846-E848
Accidental poisonings (Poisonings) Accidental poisoning by drugs, medicaments and biologicals E850-E858
Accidental poisonings (Poisonings) Accidental poisoning by other solid and liquid substances, gases and vapours E860-E869
Misadventures during surgical and medical care (Misadventures) Misadventures to patients during surgical and medical care E870-E876
Complications of surgical and medical care (Surgical complications) Surgical and medical procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at the time of procedure E878-E879
Falls Accidental falls E880-E886, E888
Fire/flames Accidents caused by fire and flames E890-E899
Environmental accidents (Environmental) Accidents due to natural and environmental factors (such as exposure to adverse weather conditions, animal bites) E900-E909
Drowning/suffocation Accidents caused by submersion, suffocation and foreign bodies E910-E915
Adverse effects in therapeutic use (Adverse effects) Drugs, medicaments and biological substances causing adverse effects in therapeutic use E930-E949
Suicide/self-injury Suicide and self-inflicted injury E950-E958
Assault Homicide and injury purposely inflicted by other persons E960-E968
Other Fracture, cause unspecified E887
Other Other accidents E916-E928
Other Late effects of accidental injury E929
Other Late effects of self-inflicted injury E959
Other Late effects of injury purposely inflicted by other person E969
Other Legal intervention E970-E978
Other Late effects of injury, undetermined whether accidentally or purposely inflicted E989
Other Injury resulting from operations of war E990-E999
Undetermined Injury undetermined whether accidentally or purposely inflicted E980-E988
External Cause (E-Code) of Injury and Poisoning Major Groupings
Specific Conditions International Classification of Diseases, Version 9 Codes
Asthma 493
Cancers - all malignant neoplasms 140-208
Cancers of specific sites - Cancer of trachea, bronchus, lung and pleura 162, 163
Cancers of specific sites - Female breast cancer 174
Cancers of specific sites - Prostate cancer 185
Cancers of specific sites - Cancer of colon, rectum, rectosigmoid junction and anus 153, 154
Chronic obstructive pulmonary disease (COPD) 490-496
Delivery in a completely normal pregnancy, labour and delivery 650
Diabetes 250
External causes of injury by intent - Intentionally inflicted injuries, suicide and homicide E950-E958, E960-E968
External causes of injury by intent - Unintentional injuries E800-E848, E850-E869, E880-E886, E888, E890-E928
Falls E880-E886, E888
Infectious diseases by frequently tabulated groupings - Croup 464.4
Infectious diseases by frequently tabulated groupings - Epiglottis, acute 464.3
Infectious diseases by frequently tabulated groupings - HIV/AIDS 042-044
Infectious diseases by frequently tabulated groupings - Measles, mumps and rubella 055, 072, 056
Infectious diseases by frequently tabulated groupings - Meningitis due to Haemophilus influenza 320.0
Infectious diseases by frequently tabulated groupings - Meningococcal meningitis 036.0
Infectious diseases by frequently tabulated groupings - Pertussis 033.0
Infectious diseases by frequently tabulated groupings - Pneumococcal diseases 038.2, 320.1, 481, 041.2
Infectious diseases by frequently tabulated groupings - Syphilis and other venereal diseases 090-099
Infectious diseases by frequently tabulated groupings - Tuberculosis 010-018
Infectious diseases by frequently tabulated groupings - Viral hepatitis, type A 070.0-070.1
Infectious diseases by frequently tabulated groupings - Viral hepatitis, type B 070.3, 070.2
Infectious diseases by frequently tabulated groupings - Viral hepatitis, other than types A and B 070.6, 070.9
Motor vehicle traffic accidents E810-E819
Newborns – healthy liveborn infants V30-V39
Pneumonia and influenza 480-487
Sudden infant death syndrome (SIDS) 798.0

Appendix 2: Rate Calculation Example

Region W

Age Group (i) Number of Separations (bi) Regional Population (ci) Age-specific Rate (ai=(bi/ci))
<1 8 2,310 0.0035
1-4 3 8,355 0.0004
5-9 5 11,963 0.0004
10-14 5 10,656 0.0005
~ ~ ~ ~
65-69 122 1,026 0.1189
70-74 99 653 0.1516
75+ 153 172 0.8895

 

Age Group (i) Age-specific Rate (ai) Indian and Northern Affairs Canada Regional Population (di) Estimated Number of Hospital Separations (ei=(ai*di))
<1 0.0035 2,686 9
1-4 0.0004 11,120 4
5-9 0.0004 13,587 5
10-14 0.0005 10,632 5
~ ~ ~ ~
65-69 0.1189 1,250 149
70-74 0.1516 963 146
75+ 0.8895 1,064 946

 

Age Group (i) Estimated Number of Hospital Separations - Region W (ei) Estimated Number of Hospital Separations - Region X (ei) Estimated Number of Hospital Separations - Region Y (ei) Estimated Number of Hospital Separations - Region Z (ei) Total ( Wei + Xei + Yei + Zei ) A Indian and Northern Affairs Canada Population ( Wdi + Xdi + Ydi + Zdi ) B Age-specific rate per 100,000 (fi= (A/ B) * 100,000)
<1 9 10 11 8 38 9,865 385.2
1-4 4 6 8 10 28 38,236 73.2
5-9 5 9 13 17 44 52,417 83.9
10-14 5 19 15 11 50 47,632 105
~ ~ ~ ~ ~ ~ ~ ~
65-69 149 150 138 163 600 5,246 11,437.3
70-74 146 153 176 197 672 3,765 17,848.6
75+ 946 1056 888 1123 4013 5,162 77,741.2

 

Age Group (i) Age-specific rate (fi) 1991 Population (hi) Estimated Number of Hospital Separations (fi*hi)
<1 0.003852 482,952 1,860.3
1-4 0.000732 452,683 331.4
5-9 0.000839 410,315 344.3
10-14 0.00105 314,363 330.1
~ ~ ~ ~
65-69 0.114373 256,397 29,324.9
70-74 0.178486 238,850 42,631.4
75+ 0.777412 237,711 184,799.4

Notes:
1991 Population (hi): ∑hi = 3,739,221
Estimated Number of Hospital Separations (fi*hi): ∑(fi*hi) = 264,884.7
Age-standardized rate per 100,000 (g=(∑(fi*hi)/∑ hi)*100,000): 7,084.0

Appendix 3: Health Services Utilization Tables

This report presents information on health services utilization in the year 2000 by the First Nations on- and off-reserve populations as identified in the British Columbia, Alberta, Saskatchewan and Manitoba provincial hospital administrative databases. Hospital separation data from the other provinces and territories were not available. As such, caution should be used when interpreting the data. Additionally, since all of the rates for First Nations have been estimated by adjusting regional rates to the Indian and Northern Affairs Canada population using methods described earlier in this report, all rate calculations are rounded to the nearest 10.

Table 1. Crude Hospital Separation Rates by International Classification of Diseases, Version 9 Chapter1, First Nations2, Western Canada, 2000

International Classification of Diseases, Version 9 Chapter Crude Rate per 100,000 population - First Nations, Western Canada2 (2000)
Infectious and Parasitic 340
Cancerous and Non-cancerous Neoplasms 310
Endocrine and Immune 540
Blood Diseases 100
Mental Disorders 1,110
Nervous System 340
Circulatory Diseases 1,000
Respiratory Diseases 2,310
Digestive Diseases 1,840
Genitourinary Diseases 780
Complications of Pregnancy, Childbirth and the Puerperium 6,960
Skin Diseases 380
Musculoskeletal 400
Congenital Anomalies 120
Perinatal Conditions 310
Symptoms and Ill-defined Conditions 1,040
Injury and Poisoning 2,090
Factors Influencing Health Status and Contact with Health Services 1,560
Total 18,080

1. International Classification of Diseases, Version 9 chapter titles and associated codes can be found in Appendix 1.
2. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba.

Notes:
a) For Complications of Pregnancy, Childbirth and the Puerperium, the female population was used as the denominator instead of the total population in the calculation of rates.
b) Due to rounding, columns may not add to total.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health.

Table 2. Age-standardized Hospital Separation Rates1, 2 by International Classification of Diseases, Version 9 Chapter3, First Nations4 and General Population5, Western Canada, 2000

International Classification of Diseases, Version 9 Chapter Age-standardized Rate per 100,000 population - First Nations4 (2000) Age-standardized Rate per 100,000 population - Western population5 (2000) Absolute Rate Difference Rank Ratio (First Nations versus general Western population) Rank
Infectious and Parasitic 390 160 220 12 2.4 5
Cancerous and Non-cancerous Neoplasms 590 590 0 16 1.0 11
Endocrine and Immune 1,030 220 820 7 4.8 1
Blood Diseases 140 80 70 15 1.9 7
Mental Disorders 1,210 580 630 8 2.1 6
Nervous System 430 210 220 11 2.1 6
Circulatory Diseases 2,390 1,270 1,130 5 1.9 7
Respiratory Diseases 3,040 920 2,110 2 3.3 3
Digestive Diseases 2,670 1,120 1,550 4 2.4 5
Genitourinary Diseases 1,090 590 500 9 1.8 8
Complications of Pregnancy, Childbirth and the Puerperium 6,190 3,310 2,890 1 1.9 7
Skin Diseases 480 110 370 10 4.3 2
Musculoskeletal 620 460 170 13 1.4 9
Congenital Anomalies 80 90 -10 17 0.8 12
Perinatal Conditions 190 370 -180 18 0.5 13
Symptoms and Ill-defined Conditions 1,580 600 970 6 2.6 4
Injury and Poisoning 2,540 960 1,580 3 2.6 4
Factors Influencing Health Status and Contact with Health Services 1,640 1,550 100 14 1.1 10
Total2 26,300 13,170 13,130      

1. The 1991 populations for British Columbia, Alberta, Saskatchewan, and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Nineteen First Nations separations with unknown age group, twenty-seven Western population separations with unknown separation date, and sixteen Western population separations with unknown age were not included in the totals for the calculation of rates.
3. International Classification of Diseases, Version 9 chapter titles and associated codes can be found in Appendix 1.
4. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba.
5. Includes the provinces of British Columbia, Alberta, Saskatchewan and Manitoba.

Notes:
a) For Complications of Pregnancy, Childbirth and the Puerperium, the female population was used as the denominator instead of the total population in the calculation of rates.
b) Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Table 3. Age-specific Hospital Separation Rates1 for All Causes (Excluding Complications of Pregnancy), by Age Group, First Nations2 and General Population3, Western Canada, 2000

Age Group

Age-specific Rate per 100,000 population - First Nations2 (2000) Age-specific Rate per 100,000 population - Western population3 (2000) Absolute Rate Difference Rank Ratio (First Nations versus general Western population) Rank
<1 98,000 118,100 -20,090 17 0.8 12
1-4 10,540 5,350 5,190 12 2.0 8
5-9 3,980 2,670 1,310 16 1.5 11
10-14 4,520 2,710 1,810 15 1.7 10
15-19 7,460 4,130 3,340 14 1.8 9
20-24 8,910 4,020 4,890 13 2.2 7
25-29 9,990 4,400 5,600 11 2.3 6
30-34 11,330 4,800 6,530 10 2.4 5
35-39 13,150 5,430 7,730 9 2.4 5
40-44 15,430 6,040 9,390 8 2.6 3
45-49 17,150 6,850 10,300 7 2.5 4
50-54 21,300 8,150 13,150 6 2.6 3
55-59 30,630 10,520 20,110 5 2.9 1
60-64 36,950 13,840 23,110 4 2.7 2
65-69 50,370 18,340 32,030 3 2.7 2
70-74 56,560 23,900 32,670 2 2.4 5
75+ 75,950 37,770 38,180 1 2.0 8
Total1 472,240 277,000 195,240      

1. Ninety-eight First Nations separations with unknown age, twenty-seven Western population separations with unknown separation date, and seventeen Western population separations with unknown age were not included in the totals for the calculation of rates.
2. Includes on- and off-reserve populations from British Columbia, Saskatchewan and Manitoba only. Alberta was excluded from the analysis due to grouping differences.
3. Includes the provinces of British Columbia, Saskatchewan and Manitoba.

Notes:
a) All Causes (excluding complications of pregnancy) refers to International Classification of Diseases, Version 9 codes 001-629, 680-999, V01-V82.
b) Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Table 4. Age-specific Hospital Separation Rates1 for All Pregnancies, Childbirth and Puerperium, by Age Group, First Nations2 and General Population3, Western Canada, 2000

Age Group

Age-specific Rate per 100,000 population - First Nations2 (2000) Age-specific Rate per 100,000 population - Western population3 (2000) Absolute Rate Difference Rank Ratio (First Nations versus general Western population) Rank
15-19 15,010 3,170 11,840 2 4.7 1
20-24 26,500 8,940 17,550 1 3.0 2
25-29 19,160 12,650 6,510 3 1.5 3
30-34 11,890 10,460 1,440 4 1.1 5
35-39 5,380 4,330 1,050 5 1.2 4
40-44 1,190 810 380 6 1.5 3
Total 79,130 40,350 38,770      

1. Only the female population was used in the rate calculation.
2. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba.
3. Includes the provinces of British Columbia, Alberta, Saskatchewan and Manitoba.

Notes:
a) All Pregnancies, Childbirth and Puerperium refers to International Classification of Diseases, Version 9 codes 630-676.
b) Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Table 5. Age-standardized Hospital Separation Rates1, 2 for Selected Chronic Conditions, First Nations3 and General Population4, Western Canada, 2000

Selected Chronic Conditions Age-standardized Rate per 100,000 population - First Nations3 (2000) Age-standardized Rate per 100,000 population - Western population4 (2000) Absolute Rate Difference Rank Ratio (First Nations versus general Western population) Rank
Ischemic heart disease 780 470 310 3 1.7 4
Cerebrovascular 340 190 150 4 1.8 3
Diabetes 780 110 670 1 7.1 1
Chronic Obstructive Pulmonary Disease (COPD) 640 260 390 2 2.5 2
Total 2,540 1,020 1,520      

1. The 1991 populations for British Columbia, Alberta, Saskatchewan and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Fifty-two First Nations separations with unknown age, seven Western population separations with unknown separation date, and three general population separations with a discharge date of 2001 were not included in the totals for the calculation of rates.
3. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba.
4. Includes the provinces of British Columbia, Alberta, Saskatchewan and Manitoba.

Notes:
a) Ischemic heart disease refers to International Classification of Diseases, Version 9 codes 410-414.
b) Cerebrovascular refers to International Classification of Diseases, Version 9 codes 430-438.
c) Diabetes refers to International Classification of Diseases, Version 9 code 250.
d) COPD refers to International Classification of Diseases, Version 9 codes 490-493.
e) Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Tables 6(a) and (b). Age-specific Hospital Separation Rates1 for Asthma (a) and Bronchitis (b), First Nations2 and General Population3, Western Canada, 2000

a)

Age Group Age-specific Asthma Rate per 100,000 population - First Nations2 (2000) Age-specific Asthma Rate per 100,000 population - Western population3 (2000) Absolute Rate Difference Rank Ratio (First Nations versus general Western population) Rank
<1 1,840 590 1,260 1 3.1 1
1-9 410 330 80 4 1.3 5
10-19 70 80 0 6 1.0 6
20-44 80 50 30 5 1.7 4
45-64 160 70 100 3 2.4 3
65+ 420 140 280 2 2.9 2
Total 2,990 1,250 1,740      

b)

Age Group Age-specific Bronchitis Rate per 100,000 population - First Nations2 (2000) Age-specific Bronchitis Rate per 100,000 population - Western population3 (2000) Absolute Rate Difference Rank Ratio (First Nations versus general Western population) Rank
<1 680 100 580 2 7.0 1
1-9 60 10 50 4 5.0 2
10-19 10 0 10 6 3.1 5
20-44 30 10 20 5 3.9 4
45-64 200 50 150 3 4.0 3
65+ 1,230 410 820 1 3.0 6
Total 2,200 580 1,630      

1. Two Western population separations with unknown age were not included in the totals for the calculation of rates.
2. Includes on- and off-reserve populations from British Columbia, Alberta (asthma only), Saskatchewan and Manitoba.
3. Includes the provinces of British Columbia, Alberta (asthma only), Saskatchewan and Manitoba.

Notes:
a) Asthma refers to International Classification of Diseases, Version 9 code 493.
b) Bronchitis refers to International Classification of Diseases, Version 9 codes 491-492.
c) Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Table 7. Age-standardized Hospital Separation Rates1 for Selected Cancers, First Nations2 and General Population3, Western Canada, 2000

Selected Cancers Age-standardized Rate per 100,000 population - First Nations2 (2000) Age-standardized Rate per 100,000 population - Western population3 (2000) Absolute Rate Difference Rank Ratio (First Nations versus general Western population) Rank
Lung cancer 80 60 20 2 1.3 2
Female breast cancer 100 110 -10 4 0.9 4
Prostate cancer 70 80 -10 5 0.8 5
Colorectal cancer 80 60 10 3 1.2 3
Cervical cancer 30 10 20 1 3.0 1
Total 360 320 30      

1. The 1991 populations for British Columbia, Saskatchewan, and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Includes on- and off-reserve populations from British Columbia, Saskatchewan and Manitoba only. Alberta was excluded from the analysis due to grouping differences.
3. Includes the provinces of British Columbia, Saskatchewan and Manitoba.

Notes:
a) For female breast cancer and cervical cancer, only the female population was used in the rate calculation.
b) For prostate cancer, only the male population was used in the rate calculation.
c) Lung cancer refers to International Classification of Diseases, Version 9 code 162.
d) Female breast cancer refers to International Classification of Diseases, Version 9 code 174.
e) Prostate cancer refers to International Classification of Diseases, Version 9 code 185.
f) Colorectal cancer refers to International Classification of Diseases, Version 9 codes 153-154.
g) Cervical cancer refers to International Classification of Diseases, Version 9 code 180.
h) Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Table 8. Age-specific Hospital Separation Rates1 for Diabetes, by Sex and Age Group, First Nations2 and General Population3, Western Canada, 2000

  Age-specific Rate per
100,000 population
First Nations2 and General Population3, Western Canada  
  First Nations2
(2000)
General
Population3
(2000)
ARD Rank Ratio Rank First Nations2
(males and females)
Age Group M F M F M F M F M F M F ARD Rank Ratio Rank
<20 30 50 40 40 -20 0 12 12 0.6 1.1 11 12 -20 8 0.6 8
20-24 130 140 50 50 80 90 10 10 2.7 2.7 8 9 0 6 1.0 5
25-29 100 110 40 60 60 60 11 11 2.3 2.0 10 11 -10 7 0.9 6
30-34 170 180 70 70 110 110 9 9 2.6 2.5 9 10 0 5 1.0 5
35-39 380 190 80 50 300 140 8 8 4.9 3.6 7 8 190 2 2.0 1
40-44 580 510 100 70 480 450 7 7 5.9 7.8 6 7 60 4 1.1 4
45-49 730 630 110 70 620 560 6 6 6.7 8.8 5 6 100 3 1.2 3
50-54 1,570 1,130 150 130 1,420 1,000 4 5 10.5 8.9 1 5 440 1 1.4 2
55-59 1,510 2,760 200 180 1,310 2,580 5 3 7.7 15.3 3 1 -1,250 11 0.5 9
60-64 2,210 2,460 270 210 1,930 2,250 3 4 8.1 11.8 2 3 -260 9 0.9 6
65-69 2,330 3,500 340 260 2,000 3,240 2 2 6.9 13.6 4 2 -1,170 10 0.7 7
70+ 2,830 4,220 480 360 2,350 3,860 1 1 5.9 11.7 6 4 -1,390 12 0.7 7
Total 12,570 15,880 1,920 1,540 10,650 14,340   -3,310  

1. Sixteen First Nations separations with unknown age were not included in the totals for the calculation of rates.
2. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba.
3. Includes the provinces of British Columbia, Alberta, Saskatchewan and Manitoba.

Notes:
a) Diabetes refers to International Classification of Diseases, Version 9 code 250.
b) All rate calculations are rounded to the nearest ten. Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Table 9. Age-standardized Hospital Separation Rates1 for Selected Communicable Diseases, First Nations2 and General Population3, Western Canada, 2000

Selected Communicable Diseases

Age-standardized rate per 100,000 population - First Nations2 (2000) Age-standardized rate per 100,000 population - Western population3 (2000) Absolute Rate Difference Ratio (First Nations versus general Western population)
Pneumonia 1,330 300 1,030 4.4
Influenza 70 20 60 4.0
Total 1,400 320 1,080  

1. The 1991 populations for British Columbia, Alberta (pneumonia only), Saskatchewan and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Includes on- and off-reserve populations from British Columbia, Alberta (pneumonia only), Saskatchewan and Manitoba.
3. Includes the provinces of British Columbia, Alberta (pneumonia only), Saskatchewan and Manitoba.

Notes:
a) Pneumonia refers to ICD-9 codes 480-486.
b) Influenza refers to ICD-9 code 487.
c) Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Table 10. Age-specific Hospital Separation Rates1 for All Injuries and Poisonings, by Sex and Age Group, First Nations2 and General Population3, Western Canada, 2000

  Age-specific Rate per
100,000 population
First Nations2 and General Population3, Western Canada  
  First Nations2
(2000)
General
Population3
(2000)
ARD Rank Ratio Rank First Nations2
(males and females)
Age Group M F M F M F M F M F M F ARD Rank Ratio Rank
<1 1,050 550 650 470 400 90 17 17 1.6 1.2 10 9 500 5 1.9 1
1-4 1,360 1,080 610 490 750 590 14 14 2.2 2.2 7 7 280 10 1.3 4
5-9 1,230 780 590 400 640 380 16 16 2.1 1.9 8 8 460 6 1.6 2
10-14 1,470 1,040 810 470 660 580 15 15 1.8 2.2 9 7 430 7 1.4 3
15-19 2,530 2,100 1,230 720 1,300 1,380 12 12 2.1 2.9 8 6 430 8 1.2 5
20-24 3,380 1,750 1,230 550 2,150 1,200 5 13 2.7 3.2 6 5 1,630 1 1.9
25-29 3,230 2,310 1,040 550 2,190 1,760 3 7 3.1 4.2 2 1 920 3 1.4 3
30-34 3,150 2,330 980 580 2,180 1,760 4 8 3.2 4.0 1 2 820 4 1.4 3
35-39 2,600 2,300 930 610 1,670 1,690 8 9 2.8 3.8 5 3 290 9 1.1 6
40-44 2,440 2,220 920 600 1,520 1,620 10 10 2.7 3.7 6 4 220 11 1.1 6
45-49 2,330 2,120 870 650 1,450 1,470 11 11 2.7 3.2 6 5 210 12 1.1 6
50-54 2,510 2,490 890 680 1,620 1,810 9 6 2.8 3.7 5 4 20 13 1.0 7
55-59 2,840 3,110 960 850 1,890 2,260 7 3 3.0 3.7 3 4 -260 16 0.9 8
60-64 3,160 3,250 1,120 1,020 2,040 2,230 6 4 2.8 3.2 5 5 -90 14 1.0 7
65-69 3,940 4,120 1,350 1,290 2,590 2,830 2 2 2.9 3.2 4 5 -180 15 1.0 7
70-74 4,840 3,840 1,780 1,760 3,060 2,080 1 5 2.7 2.2 6 7 1,000 2 1.3 4
75+ 4,110 7,410 2,980 3,970 1,130 3,440 13 1 1.4 1.9 11 8 -3,290 17 0.6 9
Total 46,180 42,800 18,940 15,650 27,250 27,150   3,380  

1. One Western population separation with unknown sex and five Western population separations with unknown separation date were not included in the totals for the calculation of rates.
2. Includes on- and off-reserve populations from British Columbia, Alberta, Saskatchewan and Manitoba.
3. Includes the provinces of British Columbia, Alberta, Saskatchewan and Manitoba.

Notes:
a) All Injuries and Poisonings refer to International Classification of Diseases, Version 9 codes 800-999.
b) Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Alberta Health and Wellness, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Table 11. Age-standardized Hospital Separation Rates1 for Intentional and Unintentional Injuries, First Nations2 and General Population3, Western Canada, 2000

Injuries Age-standardized Rate per 100,000 population - First Nations2 (2000) Age-standardized Rate per 100,000 population - Western population3 (2000) Absolute Rates Difference Ratio (First Nations versus general Western population)
Intentional 710 150 570 4.8
Unintentional 3,430 780 2,650 4.4
Total 4,150 930 3,220  

1. The 1991 populations for British Columbia, Saskatchewan, and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Includes on- and off-reserve populations from British Columbia, Saskatchewan and Manitoba only. Alberta was excluded from the analysis due to grouping differences.
3. Includes the provinces of British Columbia, Saskatchewan and Manitoba.

Notes:
a) Intentional injuries refers to International Classification of Diseases, Version 9 codes E950-E958, E960-E968.
b) Unintentional injuries refers to International Classification of Diseases, Version 9 codes E800-E848, E850-E869, E880-E886, E888, E890-E928.
c) Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Saskatchewan Health, Manitoba Health, Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Table 12. Crude Hospital Separation Rates for Selected Injuries, by Sex, First Nations1, Western Canada, 2000

External Causes of Injury Crude Rate per 100,000 population - Males Crude Rate per 100,000 population - Females Absolute Rate Difference Rank Ratio (male versus female) Rank
Motor/road vehicle 320 250 70 3 1.3 7
Other transport 80 30 50 4 2.6 2
Poisonings 70 90 -20 10 0.8 9
Misadventures 20 40 -20 9 0.6 11
Surgical complications 260 380 -120 13 0.7 10
Falls 510 560 -40 11 0.9 8
Fire/flames 50 10 40 5 7.5 1
Environmental 60 30 30 6 2.1 5
Drowning/suffocation 30 20 10 7 1.4 6
Adverse effects 90 150 -60 12 0.6 11
Suicide/self-Injury 260 470 -210 14 0.5 12
Assault 480 190 290 2 2.5 3
Other 590 270 320 1 2.2 4
Undetermined 100 110 -10 8 0.9 8
Total 2,930 2,610 330      

1. Includes on- and off-reserve populations from British Columbia, Saskatchewan and Manitoba only. Alberta was excluded from the analysis due to grouping differences.

Notes:
a) Motor/road vehicle refers to International Classification of Diseases, Version 9 codes E810-E825.
b) Other transport refers to International Classification of Diseases, Version 9 codes E800-E807, E826-E838, E840-E848.
c) Poisonings refers to International Classification of Diseases, Version 9 codes E850-E858, E860-E869.
d) Misadventures refers to International Classification of Diseases, Version 9 codes E870-E876.
e) Surgical complications refers to International Classification of Diseases, Version 9 codes E878-E879.
f) Falls refers to International Classification of Diseases, Version 9 codes E880-886, E888.
g) Fire/flames refers to International Classification of Diseases, Version 9 codes E890-E899.
h) Environmental refers to International Classification of Diseases, Version 9 codes E900-E909.
i) Drowning/suffocation refers to International Classification of Diseases, Version 9 codes E910-E915.
j) Adverse effects refers to International Classification of Diseases, Version 9 codes E930-E949.
k) Suicide/self-injury refers to International Classification of Diseases, Version 9 codes E950-E958.
l) Assault refers to International Classification of Diseases, Version 9 codes E960-E968.
m) Other refers to International Classification of Diseases, Version 9 codes E887, E916-929, E959, E969-978, E989-E999.
n) Undetermined refers to International Classification of Diseases, Version 9 codes E980-E988.
o) Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Table 13. Age-standardized Hospital Separation Rates1 for Selected Injuries, First Nations2 and General Population3, Western Canada, 2000

External Causes of Injury Age-standardized Rate per 100,000 population - First Nations2 (2000) Age-standardized Rate per 100,000 population - Western population3 (2000) Absolute Rate Difference Rank Ratio (First Nations versus general Western population Rank
Motor/road vehicle 300 130 170 4 2.4 6
Other transport 50 30 20 10 1.5 9
Poisonings 90 30 60 6 3.1 5
Misadventures 50 30 20 11 1.5 9
Surgical complications 540 430 110 5 1.3 10
Falls 880 420 470 1 2.1 7
Fire/Flames 30 10 30 9 5.6 2
Environmental 60 10 40 8 3.8 3
Drowning/suffocation 30 20 10 12 1.8 8
Adverse effects 210 160 50 7 1.3 10
Suicide/self-injury 360 100 260 2 3.7 4
Assault 280 50 230 3 5.7 1
Total 2,880 1,420 1,470      

1. The 1991 populations for British Columbia, Saskatchewan and Manitoba were used as the standard population in the calculation of age-standardized rates.
2. Includes on- and off-reserve populations from British Columbia, Saskatchewan and Manitoba only. Alberta was excluded from the analysis due to grouping differences.
3. Includes the provinces of British Columbia, Saskatchewan and Manitoba.

Notes:
a) Motor/road vehicle refers to International Classification of Diseases, Version 9 codes E810-E825.
b) Other transport refers to International Classification of Diseases, Version 9 codes E800-E807, E826-E838, E840-E848.
c) Poisonings refers to International Classification of Diseases, Version 9 codes E850-E858, E860-E869.
d) Misadventures refers to International Classification of Diseases, Version 9 codes E870-E876.
e) Surgical complications refers to International Classification of Diseases, Version 9 codes E878-E879.
f) Falls refers to International Classification of Diseases, Version 9 codes E880-886, E888.
g) Fire/flames refers to International Classification of Diseases, Version 9 codes E890-E899.
h) Environmental refers to International Classification of Diseases, Version 9 codes E900-E909.
i) Drowning/suffocation refers to International Classification of Diseases, Version 9 codes E910-E915.
j) Adverse effects refers to International Classification of Diseases, Version 9 codes E930-E949.
k) Suicide/self-injury refers to International Classification of Diseases, Version 9 codes E950-E958.
l) Assault refers to International Classification of Diseases, Version 9 codes E960-E968.
m) Due to rounding, columns may not add to total, and row differences may not equal absolute rate difference.
Source: British Columbia Ministry of Health, Saskatchewan Health, Manitoba Health; Hospital Morbidity Database, Canadian Institute for Health Information, 2007.

Acknowledgments

This report is the result of the hard work and dedication of First Nations and Inuit Health Branch, Regions and Programs Branch, the Assembly of First Nations, Indian and Northern Affairs Canada, the Public Health Agency of Canada, and the Health Data Technical Working Group, which is comprised of the organizations listed below.

Health Canada, First Nations and Inuit Health Branch

  • Health Information, Analysis and Research Division
    Diane Badger, Emily De Rubeis, Rene Dion, Karin Johnson, Cassandra Lei, Dan Lucas, Teresa Lukawiecki, Jennifer Pennock, Veeran-Anne Singh, Julie Stokes, Greg Stoodley and Susan Taylor-Clapp
  • Community Programs Directorate
    Matthew Peake
  • Office of Community Medicine
    Marene Gatali
  • Primary Health Care and Public Health Directorate
    Ulrick Auguste and Sophie Chen

Health Canada, Regions and Programs Branch

  • British Columbia Region
    John David Martin, Joanne Nelson and Shannon Waters
  • Alberta Region
    Chandrani Wijayasinghe, Trincy Buwalda, Winkie Szeto, Shelly Vik and Donatus Mutasingwa
  • Saskatchewan Region
    Sandi LeBoeuf, Carmen Bresch, Lynda Kushnir Pekrul and Erin Laing
  • Manitoba Region
    Cathy L. Menard, Suzanne Martel and Mark Sagan
  • Ontario Region
    Various staff
  • Quebec Region
    Serge Desrosiers and Jean-Pierre Courteau
  • Atlantic Region
    Agatha Hopkins, Kelly Bower and Sarah Fleming

Assembly of First Nations

Leah Bartlett and Paula Arriagada

Indian and Northern Affairs Canada

Sacha SenÚcal, Chris Penney, Eric McGregor and Kathy Hoskins

Public Health Agency of Canada

Christina Bancej, Maureen Perrin and Karen C. Roberts

Additional Resources

Federal Government

Provincial Reports

Aboriginal Organizations

International

Health Canada, Regions and Programs Branch

  • British Columbia Region
    Federal Building, Suite 540
    Sinclair Centre
    757 West Hastings Street
    Vancouver, BC V6C 1A1
    Tel: (604) 666-2083
    Fax: (604) 666-2258
  • Alberta Region
    Canada Place, Suite 730
    9700 Jasper Avenue
    Edmonton, AB T5J 4C3
    Tel: (780) 495-2651
    Fax: (780) 495-3285
  • Manitoba Region
    391 York Avenue, Suite 300
    Winnipeg, MB R3C 4W1
    Tel: (204) 983-2508
    Fax: (204) 983-3972
  • Saskatchewan Region
    2045 Broad Street, 1st Floor
    South Broad Plaza
    Regina, SK S4P 3T7
    Tel: (306) 780-7661
    Fax: (306) 780-7137
  • Ontario Region
    Emerald Plaza
    1547 Merivale Road
    Nepean, ON K1A 0L3
    Tel: (613) 952-0088
    Fax: (613) 952-5748
  • Quebec Region
    Complexe Guy-Favreau, East Tower
    200 René Lévesque Boulevard West, Room 218
    Montréal, QC H2Z 1X4
    Tel: 1-800-561-3350
    Fax: (514) 283-7392
  • Atlantic Region
    1505 Barrington Street, Suite 1525
    Halifax, NS B3J 3Y6
    Tel: (902) 426-2038
    Fax: (902) 426-3758
  • Northern Region
    60 Queen Street, Suite 1400
    Ottawa, ON K1A 0K9
    Tel: (613) 946-8081
    Fax: (613) 958-2428

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Statistical Profile on the Health of First Nations in Canada -- Health Services Utilization in Western Canada, 2000
Health Canada, First Nations and Inuit Health Branch
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