Health Inequities in Manitoba: Is the Socioeconomic Gap

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Appendix 1: Glossary 192 University of Manitoba Adjusted Rates These are rate values that are statistically adjusted to control for different age and sex distributions to ensure that the rates for all groups can be fairly compared. The adjusted values are those which the group would have had if their age and sex distribution was the same as for a standard population. Amputations Among Residents with Diabetes Residents with diabetes (aged 19 and older) who had a lower limb amputation (below or including the knee) within a three–year period. Amputation was defined by ICD–9–CM procedure codes 84.1–84.17 (ICD–10–CCI codes: 1.VC.93, 1.VG.93, 1.VQ.93, 1.WA.93, 1.WE.93, 1.WJ.93, 1.WL.93, 1.WM.93) in any procedure field. Amputations associated with accidental injury were excluded (see below for codes). Rates per 1,000 residents with diabetes were calculated for eight 3–year periods, 1984/85–2007/08 and were age– and sex–adjusted to the Manitoba population aged 19 and older in the last time period. Exclusions for accidental injury: ICD–9–CM diagnosis codes 895, 896, 897 or ICD–10–CA codes S78, S88, S98, T05.3, T05.4, T05.5, T13.6. Anxiety The proportion of residents aged 10 or older diagnosed with any of the following over a five–year period: • One or more hospitalizations with a diagnosis for anxiety states, phobic disorders or obsessive– compulsive disorders, ICD–9–CM codes 300.0, 300.2, 300.3; ICD–10–CA codes F40, F41.0, F41.1, F41.3, F41.8, F41.9, F42 • Three or more physician visits with a diagnosis for anxiety disorders, ICD–9–CM code 300 Average Household Income (Neighbourhood income) The average household income is the mean income of households at the neighbourhood income level from the Canadian census. In the census, a household refers to all persons who live within the same dwelling, regardless of their relationship to each other. Household income is the sum of incomes of all persons in the household. Individual level household income values are not available, so residents are assigned the average household income of the neighbourhood income in which they reside. In this report, average household income was calculated for the 1986, 1996 and 2006 Canadian census. Statistics Canada suppresses average household income values for dissemination areas (DAs) with populations less than 250 persons: these DAs are not included in the calculation of average household income, unless these are imputed. Beta–blockers—see Post–Acute Myocardial Infarction (AMI) Beta–Blocker Prescriptions Cervical Cancer Screening Also called a Pap (Papanicolaou) test, cervical cancer screening is based on the examination of cells collected from the cervix to reveal pre–malignant (before cancer) and malignant (cancer) changes as well as changes due to non–cancerous conditions such as inflammation from infections. In this study, cervical cancer screening was measured as the crude and adjusted proportion of women aged 18–69 who received at least one Pap test in three fiscal years was defined by: • A physician visit with a tariff code for a Pap test: • 8470—regional gynaecological exam, including cytological smear of the cervix, provided by a (GP/FP) • 8495—complete physical and gynaecological exam, including cytological smear of the cervix, provided by an OB/GYN specialist
Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time? • 8496—regional gynaecological exam, including cytological smear of the cervix, provided by an OB/GYN specialist • 8498—complete physical and gynaecological exam, including cytological smear of the cervix, provided by a GP/FP • 9795—cytological smear of the cervix for cancer screening • A pathology or laboratory claim with a tariff code for a Pap test: • 9470—Cytological Examination—Vaginal Smear The denominator includes all Manitoba female residents aged 18–69 in the three–year period, except as noted below. Note that if a laboratory claim and a physician claim for a Pap test for the same individual are within 54 days of each other, they are counted as one Pap test to reduce double counting over three–year periods. Nearly all of lab claims are within 54 days of the physician claim. Women who have had a complete hysterectomy surgery were excluded from both the numerator and denominator. Hysterectomy surgeries were defined by hospital separations with ICD–9–CM procedure codes 68.4–68.9 and ICD–10–CCI codes 1.RM.89, 1.RM.91, 5.CA.89.CK, 5.CA.89.DA, 5.CA.89.GB, 5.CA.89. WJ, and 5.CA.89.WK. These codes include only total hysterectomies, not partial, as women who have a partial hysterectomy may still have a cervix and would require cervical cancer screening. Rates for northern and remote areas served by nursing stations may be underestimated due to missing data. Prior to 2005, only physicians were able to code into the administrative billing system for Pap tests. As of 2005, nurses officially called “Nurse Practitioners” by Manitoba Health were able to record claims in the physician data system. However, “Advanced Practice Nurses” or other designations are not included in the Nurse Practitioner designation, despite the fact that some do Pap tests. Nurses working at federally–operated Nursing Stations also do not record their work in the billing claims system. However, most nurses who are not nurse practitioners would be doing Pap tests under the supervision of a physician, who would most likely be billing for these. At the time of this study, the Repository at MCHP did not have access to laboratory data, so Pap tests are only observable through the billing system. Continuity of Care The extent to which individuals see a given healthcare provider (versus one or more other providers) over a two–year period. In this study, ‘good’ continuity of care is when a resident receives at least 50% of his or her ambulatory care from the same healthcare provider over the time period. A provider may be defined either as an individual physician, a physician group practice, or a clinic. Individuals with less than three visits to a healthcare provider were excluded from analyses. Tables describing the proportion of the population excluded from these analyses are below. Proportion Excluded from Analyses (because they had less than three MD visits over two years) For Children aged 14 and younger Time Period Frequency Percent T1: 1984/85–85/86 51954 8.78 T2: 1986/87–87/88 48278 8.16 T3: 1988/89–89/90 47291 7.99 T4: 1990/91–91/92 43987 7.43 T5: 1992/93–93/94 45908 7.76 T6: 1994/95–95/96 42425 7.17 T7: 1996/97–97/98 49001 8.28 T8: 1998/99–99/00 48720 8.23 Manitoba Centre for Health Policy 193
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HEALTH INEQUITIES IN MANITOBA: Is t
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About the Manitoba Centre For Healt
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Dr. Patricia Martens acknowledges t
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Key findings: High School Completio
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List of Figures Figure 1.1 Distribu
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Figure 4.27 Adjusted Lorenz Curve f
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Figure 6.15 Hospitalization Due to
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List of Tables Table E.1 Changes in
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Figure A3.6 Adjusted Lorenz Curve f
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Executive Summary Health status and
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(derived from Table E.1’s columns
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Table E.1: Continued Indicator RURA
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Table E.1: Continued Indicator RURA
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Table Table E.2: E.2: Is Is the the
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This page edited May 18, 2011. Tabl
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References Commission on Social Det
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Health Inequities in Manitoba: Is t
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Table 2.1: Neighbourhood Income Qui
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Table 2.3: Neighbourhood Table 2.3:
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Figure 3.2: Premature Mortality Rat
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Figure 3.10: Potential Years of Lif
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Cumulative Percent of Potential Yea
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Figure 3.18: Under Five Mortality R
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Figure 4.2: Teen Pregnancy Rates Ov
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Figure 4.10: High School Completion
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Figure 4.18: Dental Extraction Rate
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Figure 4.26: Breastfeeding Initiati
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References: Health Inequities in Ma
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Figure 5.2: Diabetes Prevalence Ove
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Figure 5.10: Amputations Among Figu
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Figure 5.18: Ischemic Heart Disease
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Figure 5.26: Multiple Sclerosis Pre
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References: Health Inequities in Ma
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Figure 6.2: Continuity of Care Prev
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Figure 6.10: Hospitalization Due to
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CONFIDENTIAL -- NOT FOR DISTRIBUTIO
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Page 195 and 196: Reference Health Inequities in Mani
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Page 209 and 210: Table 9.1: Continued Indicator RURA
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Page 263 and 264: Figure A3.2: High School Appendix C
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Health Inequities in Manitoba: Is the Socioeconomic Gap

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