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HOW HEALTHY ARE THERESIDENTS OF PEEL?Multiple measures must be used to create a fullpicture of the health of a population. In thissection, we provide several perspectives on thehealth of Peel’s population, including self-ratedhealth, mortality, hospital discharges andemergency department visits.
It is important to keep in mind that themagnitude of disease in a population is not the only factor affecting these measures. For example, the rate of hospitalizations wouldbe affected by the prevalence of disease, but itcould also be influenced by the availability ofhospital beds and changing patterns of medicalcare, including the shift from inpatient tooutpatient care.
52
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chapter 5 • how healthy are the residents of peel?
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Self-rated health predicts later disability and mortality
Self-rated health is an individual’s assessment ofhis or her general health. Many studies havedemonstrated that self-rated health is animportant predictor of disability and mortality.1–6
In 2005 in Peel, 89% of residents reported thattheir health was excellent, very good or good.This is similar to the proportion in the otherregions of the Greater Toronto Area and acrossOntario as a whole. Among Peel residents, thereis no difference by sex in self-rated health. Thoseaged 45 to 64 years and 65 years and older areless likely than younger age groups to report thattheir health is excellent, very good or good(Figure 5.1).C
The number of chronic conditions a person has increases with age
Forty-seven per cent of Peel residents reporthaving at least one chronic condition. This figureis significantly lower than Ontario’s rate of 52%.In both Peel and Ontario, the number of chronicconditions reported is strongly related to age.Among Peel residents aged 65 years and older,
87% have at least one chronic condition (Figure 5.2 on next page).C
A chronic condition is defined as acondition lasting, or expected to last, at least six months and which has been diagnosed by a health professional.
Figure 5.1Self-Rated Health† by Age Group,Peel, 2005
Age group (years) 12-19
† Defined as excellent, very good and goodSource: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care
Per cent of population aged 12 years and older94.4
20-44
93.4
45-64
84.7
65+
71.0
0
20
40
60
80
100
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Figure 5.3 shows the common chronic conditionsreported by Ontario residents.
Hearing and vision problems are common in the elderly
In 2003, 11% of Canadian seniors reported thatthey had a hearing problem. Self-reportedhearing problems among seniors increased withage from 5% of those aged 65 to 69 years to 23% of those aged 80 years and older.
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Figure 5.2Population with at Least One Self-Reported Chronic Condition†,Peel and Ontario, 2005
Per cent of population aged 12 years and older
Age group (years)12-19 20-44 45-64 65+
Peel Ontario
† Diagnosed by a health care professionalSource: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care
16.521.4
36.939.4
65.7 66.3
87.1 87.8
0
20
40
60
80
100
Per cent of population aged 12 years and older
Back ProblemsArthritis and Rheumatism
High Blood PressureAsthma
Mood DisorderThyroid
DiabetesHeart Disease
Cataracts††
Anxiety DisorderBowel Disorder
UlcersBronchitis
CancerGlaucoma††
Effects of a StrokeCOPD†††
Emphysema†††
EpilepsyAlzheimers/Dementia††
Eating DisorderSchizophrenia
Figure 5.3Prevalence of Selected Self-Reported Chronic Conditions†,Ontario, 2005
† Diagnosed by a health care professional†† Among the total population 18 years and older††† Among the total population 30 years and olderSource: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care
0 5 10 15 20 25
19.517.2
15.48.0
6.05.3
4.84.8
4.54.3
4.1
1.51.5
0.70.7
0.50.40.30.3
1.1
3.12.4
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Hearing problems were more prevalent amongmale seniors than female seniors (12% vs. 9%).7
In 2003, about half of the Canadian populationhad some type of vision problem. The mostserious problems were experienced by olderadults. Vision problems were reported by 82% ofCanadian seniors. A similar proportion wasreported for Ontario. Seventy-eight per cent ofCanadian seniors with vision problems reportedthat their difficulties had been corrected (forexample, with glasses or contact lenses), while4% reported “uncorrected” problems (includingproblems not amenable to correction).8 Twenty-five per cent of falls causing injury amongseniors are attributed to vision problems.9
The three most common causes of visionproblems are cataracts, glaucoma and age-relatedmacular degeneration.
The prevalence of cataracts increases with ageand has increased over time in Canada.8 In 2005,24% of Ontario seniors and 20% of Peel seniorsreported being diagnosed with cataracts by ahealth care professional.C
According to the Canadian National Institute forthe Blind, one million Canadians are affected bysome form of age-related macular degeneration.With the expected aging of the population, thenumber of Canadians affected by age-relatedmacular degeneration is expected to doublewithin the next 25 years.10
In 2003, 6% of Canadian seniors reported beingdiagnosed with glaucoma by a health careprofessional, with the prevalence being higheramong women.8 In Ontario, the prevalence ofglaucoma increases with age (Figure 5.4).C
chapter 5 • how healthy are the residents of peel?
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Figure 5.4Prevalence of Cataracts and Glaucoma† by Age Group,Ontario, 2005
Per cent of population aged 12 years and older
Age group (years)18–49 50–64 65–74 75+
Cataracts Glaucoma
† Diagnosed by a health professional* Use estimate with cautionSource: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care
0.5* 0.3*
4.22.0
18.6
4.5
30.3
8.7
0
5
10
15
20
25
30
35
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BURDEN OF DISEASE
In this section, seven selected health conditionswere examined and compared to illustrate theburden of chronic conditions in Ontario and thecorresponding burden of mortality, hospitaliza-tions and emergency department visits. Thesehealth conditions displayed some or all of the following characteristics: they were highly prevalent, caused many deaths, led to long hospital stays, resulted in many emergencydepartment visits or had large direct or indirecthealth care costs. The health conditions examined were:
• Cardiovascular disease • Cancer (all types combined)• Diabetes• Injuries, accidents and suicides• Arthritis and rheumatism• Respiratory disease (asthma and chronic
obstructive pulmonary disease)• Mental health disorders (schizophrenia and mood
disorders)
Figure 5.5 shows that each condition or diseasehas a different profile in terms of prevalence,mortality, hospitalizations and emergencydepartment visits. Cardiovascular disease, which includes ischaemic heart disease andstroke (cerebrovascular disease), had the highestmortality rate and high rates of hospitalizationand emergency department visits, while cancerhad the highest rate of premature death. Thecategory of injuries, accidents and suicides had a relatively low rate for mortality, but high ratesfor premature death, hospitalizations andemergency department visits. For mental healthdisorders and respiratory disease, the rates forhospitalizations and emergency department visitswere higher than those for mortality. Fordiabetes, the rates for mortality, hospitalizationsand emergency department visits were relativelylow, but the associated illnesses, such ascardiovascular disease, have a much moresignificant impact.
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Figure 5.5Burden of Selected Health Conditions,
Ontario, 2004, 2005, 2006
Mortal
ity Ra
te - 2
004 (
per 10
0,000
)
PYLL
†† Rate
- 200
4 (per
100,0
00)
† Diagnosed by a health care professional†† PYLL = Potential Years of Life LostSources: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term CareOntario Mortality Database 2004, HELPS (Health Planning System), Ministry of Health PromotionHospital In-Patient Discharges Data 2005 and Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term CareNational Ambulatory Care Reporting System 2006
Hospita
lizatio
n Rate
- 200
5 (per
100,0
00)
ED Visit
Rate
- 200
6 (per
100,0
00)
Preva
lence
-200
5 (per
100,0
00)
Cardiov
ascu
lar
diseas
e
Cance
r (all)
Diabete
s
Injuri
es, a
cciden
ts
and su
icides
Arthrit
is an
d
rheum
atism
Respira
tory
diseas
e
Mental
healt
h
disord
ers0
200
400
600
800
1000
1200
1400
177.
071
2.4
936.
01,
164.
6
5,60
0.0
168.
91,
339.
5
416.
710
2.9
1,50
0.0
20.7
108.
5 88.1 189.
14,
800.
033
.583
6.6
1,18
9.6
11,0
01.1
1,40
7.8
13,6
00.0
2.6 20
.029
0.3
17,2
00.0
21.2 56
.524
5.0
1,09
2.7
8,60
0.0
0.5 3.
925
6.2 37
3.4
6,10
0.0
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Canadians have a life expectancy of 81.2 years atbirth (Figure 5.6).
Within Canada, the province of British Columbiahas the highest life expectancy at birth for bothmales and females. Males in British Columbiaare expected to live almost three years longerthan their counterparts in Newfoundland andLabrador. In all provinces, females are expectedto live longer than males.
Life expectancy in Canada increased at firstbecause of a dramatic fall in infant mortality;more recently, the increase has resulted fromreduced mortality rates among older age groups(Figure 5.7).
In 2004 in Peel, life expectancy at birth was 84.1years for females and 80.2 years for males. InOntario, life expectancy was lower at 82.6 yearsfor females and 78.2 years for males. Between1986 and 2004 in Peel and Ontario, lifeexpectancy increased for both males and females.The improvement in life expectancy was greaterfor males than females, thus reducing the gapbetween the sexes. Life expectancy in Peel isconsistently higher than in Ontario.
Historic Life Expectancy in Canada
The life expectancy of Canadians hasbeen continually increasing. Femaleshave a longer life expectancy thanmales. The gap between males andfemales was particularly wide until1982, but the difference hasdecreased since then.
?Life expectancy estimates the averageage at death for a group or cohort atbirth. Life expectancy is calculatedbased on the current mortality ratesexperienced by all age groups in thepopulation.
chapter 5 • how healthy are the residents of peel?
57
Canada
Japan
United Kingdom
Italy
Portugal
United States
Jamaica
Poland
India
China
Swaziland
Figure 5.6Life Expectancy at Birth,Selected Countries, 2008
Source: CIA World Factbook, 2008, available at: https://www.cia.gov/library/publications/the-world-factbook/rankorder/ 2102rank.html
0 20 40
Life expectancy (years)
60 80 100
82.1
81.2
80.1
78.9
78.1
78.0
75.4
73.6
73.2
69.3
32.0
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Health: Quantity and Quality
Life expectancy is a measure of expected lengthof life. Health-adjusted life expectancy (HALE)is a more comprehensive indicator that takes intoaccount quality of life. Years lived in poor healthare counted as equivalent to only part of a fullyear of good health.
In Peel in 2004, HALE was 73.9 years for malesand 76.3 years for females. Although females areexpected to live more years in poor health, theyalso live more of their years in good health,compared to their male counterparts (Figure 5.8).
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Figure 5.8Life Expectancy at Birth and Health-Adjusted Life Expectancy (HALE),Peel, 1986–2004
Year
1986 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 20041987
Source: Ontario Mortality Database 1986-2004, HELPS (Health Planning System), Ministry of Health PromotionPopulation Estimates 1986-2004, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care
Life Expectancy Males Life Expectancy Females HALE Males HALE Females
Age in years
0
60
70
80
90
100
Figure 5.7Life Expectancy at Birth by SexCanada, 1920–2002
Year
1920–22 1930–32 1940–42 1950–52 1960–62 1970–72 1980–82 1990–92 2002
Sources: Statistics Canada, Available at: http://www40.statcan.ca/l01/cst01/health26.htmSt-Arnaud J, Beaudet M, Tully P. Life Expectancy. Health Reports 17(1):43-47. 2005
Males Females
0
10
20
30
40
50
60
70
80
90Age in years
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Disability Among Peel residents in 2005:
• Ten per cent “often” experienced an activitylimitation at home, school, work or otherlocation, and 16% “sometimes” experienced suchan activity limitation.
• Eleven per cent needed assistance with activitiesof daily living.
• Nine per cent had stayed in bed or cut down onnormal activities in the previous two weeks dueto illness or injury. Of those 9%, over two thirdsof residents reported staying in bed or cuttingdown on their normal activities for three days orless in the previous two weeks.
• Females were more likely to report all threemeasures of disability than males (Figure 5.9).C
Increasing age is accompanied by an increase inactivity limitation and in the need for assistancewith the activities of daily life (Figure 5.10 onnext page). By age 65 years and older, half ofPeel residents have an activity limitation andalmost one third require assistance with theactivities of daily living. As the population ofPeel ages, the proportion of residents reporting adisability will increase, and the need for assistiveprograms and services will rise accordingly.
Activity restriction is defined as beinglimited in activities (including at home,school and work) due to a physicalcondition, mental condition or healthproblem that had lasted, or wasexpected to last, six months or longer.
The need for assistance with the activities of daily living is defined asreporting the need of assistance fromanother person to carry out activitiesassociated with daily living, such aspersonal care (washing, dressing, eating), moving about inside the house or instrumental activities (mealpreparation, shopping, normal housework).
Two week disability is defined as having stayed in bed or cut down onnormal activities one or more days inthe previous two weeks due to illnessor injury.
chapter 5 • how healthy are the residents of peel?
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Figure 5.9Activity Limitations by Sex,Peel, 2005
Per cent of population aged 12 years and older
Activity Limitation(Often + Sometimes)
Needs Assistance with Activitiesof Daily Living
Two Week Disability
Male Female
Source: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care
23.0
29.4
6.4
16.0
5.2
12.6
0
5
10
15
20
25
30
35
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Mortality
In Ontario between 1922 and 2004, the crudemortality rate decreased. Throughout this period,females experienced a lower crude mortality ratethan males (Table 5.1).
In Peel between 1986 and 2004, the age-standardized mortality rate also decreased(Figure 5.11 on next page). Peel’s age-standardized mortality rate has been consistentlylower than Ontario’s.
The crude mortality rate is the totalnumber of deaths divided by the totalpopulation, usually expressed per100,000 population.
The age-standardized mortality rate isa calculation that allows for compar-isons between populations and overtime. Age-standardized rates are morecomparable because differences in agedistribution have been removed.
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Figure 5.10Activity Limitation by Age Group,Peel, 2005
Per cent of population aged 12 years and older
Activity Limitation(Often + Sometimes)
Needs Assistance with Activitiesof Daily Living
Age group (years)
Two Week Disability
12–19 20–44 45–64 65+
Source: Canadian Community Health Survey 2005, Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care
16.819.3
34.1
51.0
2.67.6
14.7
31.5
6.9 8.210.5 10.6
0
10
20
30
40
50
60
Table 5.1Crude Mortality Rates† by Sex,Ontario, 1922–2004
† Rate per 1,000 populationSources: 1922, 1947, 1960, 1989 Vital Statistics, Office of the Registrar GeneralOntario Mortality Database 2004, HELPS (Health Planning System), Ministry of Health Promotion
1922 1947 1960 1989 2004
Male 11.8 10.8 9.6 8.0 6.8
Female 11.1 9.0 7.3 6.9 6.6
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Figure 5.12 shows the age-specific mortality ratesfor males and females in Peel. Typically, mortalityrates for both sexes are high at birth and decline inearly childhood. From ages 10 to 35 years, risk-taking behaviour causes males to have a highermortality rate than females – for the most partthese deaths are preventable.
Figure 5.13 (next page) shows the age-standardized mortality rates for selected causes inOntario from 1969 to 2000. For certain causes,like ischaemic heart disease, the mortality ratehas decreased dramatically.
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Figure 5.11Mortality Rates by Sex,Peel, 1986–2004
Year1995 1996 1997 1998 1999 2000 2001 2002 2003 20041986 1987 1988 1989 1990 1991 1992 1993 1994
Source: Ontario Mortality Database 1986-2004, HELPS (Health Planning System), Ministry of Health PromotionPopulation Estimates 1986-2004, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care
Male Female
0
200
400
600
800
1,000Age-standardized number of deaths per 100,000 population
Figure 5.12Age-Specific Mortality Rates by Sex,Peel, 2004
Age group (years)<1 1-4 5-9 15-1910-14 20-24 25-29 30-34 40-4435-39 45-49 50-54 55-59 60-64 70-7465-69 75-79 85-8980-84 90+
Source: Source: Ontario Mortality Database 2004, HELPS (Health Planning System), Ministry of Health PromotionPopulation Estimates 2004, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care
Male Female
1
10
100
1,000
10,000
100,000Number of deaths per 100,000 population in logarithmic scale
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In 2004, the leading causes of death in Peel wereischaemic heart disease, lung cancer, and stroke
Very few deaths occur among children under theage of 19 years. The majority of deaths occuramong residents aged 65 years and older, with
ischaemic heart disease, stroke (cerebrovasculardisease) and lung cancer being the most commoncauses. Suicide and land transport accidents arethe most common causes of mortality amongthose aged 20 to 44 years (Figure 5.14).
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Figure 5.14Most Common Causes of Death by Age Group,Peel, 2000–2004 Combined
Source: Ontario Mortality Database 2000-2004, HELPS (Health Planning System), Ministry of Health PromotionPopulation Estimates 2000-2004, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care
0 to 19 years:Perinatal conditionsCongenital anomaliesLand transport accidentsAll other causes
65+ years:Ischaemic heart diseaseStrokeLung cancerAll other causes
20 to 44 years:SuicideLand transport accidentsIschaemic heart diseaseAll other causes
45 to 64 years:Ischaemic heart diseaseLung cancerBreast cancerAll other causes
2.8%
6.0%
20.1%
71.1%
Figure 5.13Mortality Rate for Selected Causes,Ontario, 1969–2000
Year
Source: Chronic Disease Infobase, Public Health Agency of Canada, Available at: http://204.187.39.30/surveillance/ Mapdb/Infobase_e.htm
Cancer Ischaemic heart disease Stroke Diabetes Injury and poisoning
400
350
300
250
200
150
100
50
0
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Age-standardized number of deaths per 100,000 population
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Dying Young In Peel in 2004, cancer was the leading cause ofpotential years of life lost (Figure 5.15). Injuriesand accidents, ischaemic heart disease andsuicide were the next most common causes ofpotential years of life lost.
Ischaemic heart disease was the leading cause ofpremature death among males, while breastcancer was the second leading cause amongfemales (Table 5.2 on next page). Althoughdeaths due to perinatal conditions were few innumber in Peel in 2004, they are an importantcontributor to PYLL due to the strong influenceof the 75 years of life lost in each case.
The number of potential years of lifelost (PYLL) is a measure of prematuredeath. It is the sum of all the yearsnot lived by all the individuals in apopulation who die prior to age 75.PYLL weights death at a young age more heavily than death at anolder age.
chapter 5 • how healthy are the residents of peel?
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Figure 5.15Potential Years of Life Lost by Selected Causes,Peel, 2004
Per cent of total potential years of life lost
† Many deaths associated with diabetes have ischaemic heart disease or renal failure recorded as the cause of death†† COPD – Chronic Obstructive Pulmonary DiseaseSource: Ontario Mortality Database 2004, HELPS (Health Planning System), Ministry of Health PromotionPopulation Estimates 2004, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care
Ischaemic heart disease
Injuries and accidents
Suicide
Stroke
Diabetes†
Asthma and COPD††
All others
Cancer
0 5 10 15 20 25 30 35 40
32.5
10.9
8.4
5.5
2.6
1.6
1.0
37.4
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Going to Hospital
In Peel in 2005 the number of hospitalizationsamong females was substantially higher thanamong males (Table 5.3 and 5.4 on next page).This can be explained by the large number of hospitalizations related to pregnancy and childbirth.
Peel residents are less likely than their Ontariocounterparts to visit an emergency department
The emergency departments in Peel hospitalsprovide emergency and non-urgent care to a highvolume of patients of all ages with a wide range
of conditions. In 2006, Peel residents made286,530 emergency department visits (Table 5.5on page 66). The rate of emergency departmentvisits for males and females in Peel werecomparable. Peel residents were much less likely than their Ontario counterparts to visit an emergency department. This pattern might be explained by regional variations in theavailability of physicians, walk-in clinics and/orurgent care centres.
Rates of emergency department visits are highestin the older age groups and among childrenyounger than 10 years of age.
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Table 5.2Potential Years of Life Lost by Selected Causes by Sex,Peel, 2004
Source: Ontario Mortality Database 2004, HELPS (Health Planning System), Ministry of Health Promotion
MALES # PYLL FEMALES # PYLL
Ischaemic heart disease 2,608 Perinatal conditions 1,875
Perinatal conditions 2,014 Breast cancer 1,616
Intentional self-harm 1,530 Congenital malformations, deformations, & chromosomal abnormalities 1,069
Land transport accident 1,494 Lung cancer 981
Lung cancer 1,352 Ischaemic heart disease 685
Cancer of the lymph,blood & related tissues 902 Intentional self-harm 602
Colorectal cancer 771 Cancer of the lymph, blood & related tissue 587
Stroke 627 Colorectal cancer 559
Congenital malformations,deformations, & chromosomalabnormalities 621 Stroke 401
Cirrhosis and otherdiseases of liver 607 Ovarian cancer 322
All other causes 11,056 All other causes 6,720
All causes 23,582 All causes 15,417
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Table 5.3Hospital Discharges for Females,Peel, 2005
† Puerperium defined as the period immediately after childbirthNote: Sex information was unknown for 28 hospitalizationsSource: Hospital In-Patient Discharge Data 2005, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care
Selected Cause Number Total # of days
Conditions associated with pregnancy, childbirth and the puerperium† 15,350 35,269
Injury and poisoning 2,132 14,807
Arthritis/Rheumatism 1,561 8,587
Ischaemic heart disease 1,125 7,707
Chronic obstructive lung disease 1,064 6,882
Mood disorder 811 11,953
Pneumonia and influenza 646 4,106
Heart failure 629 5,703
Short gestation and low birth weight 597 7,987
Pregnancy with abortive outcome 587 814
All other causes 19,698 121,580
All causes 44,200 225,395
Table 5.4Hospital Discharges for Males,Peel, 2005
Note: Sex information was unknown for 28 hospitalizationsSource: Hospital In-Patient Discharge Data 2005, Provincial Health Planning Database (PHPDB), Ontario Ministry of Health and Long-Term Care
Selected Cause Number Total # of days
Ischaemic heart disease 2,555 14,792
Injury and poisoning 2,422 14,178
Chronic obstructive lung disease 1,157 6,070
Arthritis/Rheumatism 1,120 4,871
Short gestation and low birth weight 731 10,575
Pneumonia and influenza 678 4,359
Hernia 597 1,972
Heart failure 596 5,669
Stroke 593 7,200
Diseases of appendix 543 1,392
Other causes 18,141 124,291
All Causes 29,133 195,369
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In Peel in 2006, injuries and poisonings were theleading cause of emergency department visits,followed by arthritis and rheumatism and chronicobstructive lung disease (Table 5.5).
Among children and youth, the most commoncauses of emergency department visits wereinjuries and poisonings, diseases related to theear, and respiratory conditions. Injuries andpoisonings are the cause of almost 40% ofemergency department visits by children agedone to 19 years (Table 5.6).
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Table 5.6Emergency Department Visits among Children Aged One to 19 Years,Peel, 2006
Source: National Ambulatory Care Reporting System Data 2006, Provincial Health Planning Database (PHPDB),Ontario Ministry of Health and Long-Term Care
Cause Number
Injury and poisoning 26,561
Diseases of the ear and mastoid process 2,811
Chronic obstructive lung disease 2,811
Arthritis and rheumatism 1,126
Pneumonia and influenza 1,111
Acute bronchitis and bronchiolitis 793
All other causes 34,901
All Causes 70,114
Table 5.5Emergency Department Visits,Peel, 2006
Source: National Ambulatory Care Reporting System Data 2006, Provincial Health Planning Database (PHPDB),Ontario Ministry of Health and Long-Term Care
Cause Number
Injury and poisoning 80,304
Arthritis and rheumatism 8,870
Chronic obstructive lung disease 7,154
Pneumonia and influenza 3,214
Ischaemic heart disease 2,312
All other causes 184,676
All causes 286,530
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