英文PPT课件ChronicobstructivepulmonarydiseaseCOPD 70页

TableofContentsSlidesSources...................................................................................3Background...........................................................................4–5Methodology..........................................................................6–7KeyFindingsDegenerativejointdisease(osteoarthritis).....................Ischemicheartdisease(IHD)...........................................Arrhythmia.........................................................................Chronicobstructivepulmonarydisease(COPD)..........Cerebrovasculardisease..................................................8–1920–3132–4344–5657–68InterpretativeCautions.........................................................69–70 SourcesBreezingAM,WatsonDE,BlackC.Chronicconditionsandco-morbidityamongresidentsofBritishColumbia.Vancouver:CentreforHealthServicesandPolicyResearch;2005.JohnsHopkinsBloombergSchoolofPublicHealth.TheJohnsHopkinsAdjustedClinicalGroups(ACG)Case-MixSystemReferenceManual.Version7.0.Baltimore:TheJohnsHopkinsUniversity;2005.JohnsHopkinsBloombergSchoolofPublicHealth.TheJohnsHopkinsAdjustedClinicalGroups(ACG)Case-MixSystemTechnicalUserGuide.Version7.0.Baltimore:TheJohnsHopkinsUniversity;2005. Background:ChronicdiseasesaffectasignificantnumberofCanadians;accountforalargeproportionofhealthcareserviceutilizationandassociateddirectandindirecthealthcarecosts;aremorecommonwithincreasingageandlowersocioeconomicstatus;areoftenassociatedwithmodifiableriskfactorssuchastobaccouse,unhealthydietandlackofphysicalactivity;aresubjecttodelayedonset;andareoftenconsideredtobepreventable.CentreforHealthServicesandPolicyResearch(CHSPR)attheUniversityofBritishColumbiaidentifiedeleven“high-impactand/orhigh-prevalence”chronicconditions.Combination—prevalenceandimpact—hasimportantimplicationsfortheplanningandallocationofhealthcareresources. Background(cont’d):UsedtheExpandedDiagnosisClusters(EDCs)JohnsHopkinsACGCase-MixSystem(version7.0)toolEstimated“treated”prevalenceinOntariofor2006/07for5ofthe11high-impactand/orhigh-prevalencechronicdiseases,including:Degenerativejointdisease(osteoarthritis)Ischemicheartdisease(IHD)CardiacarrhythmiaChronicobstructivepulmonarydisease(COPD)CerebrovasculardiseasePrevalenceratesforotherchronicconditions(diabetes,asthma,cancer,congestiveheartfailureandhypertension)notreportedusingtheACGSystemalreadybeingmeasured,orwillbemeasuredinthenearfuture,usingvalidatedalgorithmsdevelopedbyICESandCancerCareOntario. Methodology:Fiscalyear2006/07Cohort=Ontarians(derivedfromtheRegisteredPersonsDatabase[RPDB])EDCalgorithmappliedtoCanadianInstituteforHealthInformation’sDischargeAbstractDatabase(CIHI-DAD)andOntarioHealthInsurancePlan(OHIP)recordsoveratwo-yearperiod(April1,2005toMarch31,2007)AlgorithmmappedCIHI-DADandOHIPtothefollowingEDCs:Degenerativejointdisease:MUS03Ischemicheartdisease(excludingacutemyocardialinfarction):CAR03Cardiacarrhythmia:CAR09Emphysema,chronicbronchitis,COPD:RES04Cerebrovasculardisease:NUR05 Exclusions:Personslessthan20yearsofage(lessthan35yearsofageforcalculationofCOPDrates)Out-of-provinceresidentsRecordswithmissing/invalidage,sex,and/orLHINinformationIndividualswhodiedorwhosedateoflastcontactwiththehealthcaresystemwasgreaterthan5yearsPopulationestimates(asofApril1,2006)werecalculatedusingtheRPDB.Age-andsex-adjustedprevalencerateswerestandardizedusingOntario’s2001censuspopulation.Neighbourhoodmedianhouseholdincomerankedbyquintiles(obtainedfromStatisticsCanadacensusdata)usedasestimateofsocioeconomicstatus(SES)Methodology(cont’d): Osteoarthritis(degenerativejointdisease)MostcommonformofarthritisCausesbreakdownofcartilage(coversandprotectstheendsofbonesinjoints)Commonlyaffectsjointsinthehands,feetandspineandlargeweight-bearingjoints(hipsandknees)causingpain,swelling,stiffness,reducedrangeofjointmotion,disabilityineverydaylivingactivitiesandmobilityGreaterriskforindividualsthatareolder,overweight,haveafamilyhistoryofosteoarthritisand/orpreviousjointinjuryNocure;treatments(e.g.,medication,exercise,physiotherapy,weightloss)canincreasejointmobilityanddecreasepainanddisability.Inseverecases,surgerymaybeperformedtoreplacetheentirejoint,especiallythehiporknee. KeyFindings:OsteoarthritisOverallprevalencerates(2006/07)In2006/07,littlevariationinprevalenceratesamongLHINsTwelveoutof14LHINprevalencerateswerewithin10%oftheOntariorate(9.3per100persons).Highest(11.3per100persons)andlowest(7.6per100persons)rateswereobservedintheErieSt.ClairandWaterlooWellingtonLHINs,respectively. Age-andsex-adjustedprevalencerateofosteoarthritisper100Ontariansaged20yearsandolder,2006/07ByLocalHealthIntegrationNetwork(LHIN)inOntario Age-andsex-adjustedprevalencerateofosteoarthritisper100Ontariansaged20yearsandolder,bysub-LHINplanningarea,2006/07LHIN1(ErieSt.Clair)vs.Ontario KeyFindings(cont’d):OsteoarthritisPrevalenceratesbysexand/oragegroup(2006/07)RatesformenandwomeninOntarioincreasedwithage,levelingoffafter74yearsofage.Forwomen,thoseaged75–84hadhighestprevalencerates;formen,rateswerehighestinthe85+agegroup.Forbothmenandwomen,50–64agegrouphadhighestvolume(numberofcases).Acrossallagegroups,prevalenceratesconsistentlyhigherinwomenthaninmenattheOntariolevelandinmostoftheLHINs.Disparitywasgreatestinthe50–64agegroupwheretheratesforwomenwere51%higherthanthoseformen. Prevalencerateofosteoarthritisper100Ontariansaged20yearsandolder,bysexandagegroup,2006/07 Prevalencerateofosteoarthritisper100Ontariansaged20yearsandolder,bysexandagegroup,2006/07LHIN1(ErieSt.Clair)vs.Ontario Age-adjustedprevalencerateofosteoarthritisper100Ontariansaged20yearsandolder,bysexandsub-LHINplanningarea,2006/07LHIN1(ErieSt.Clair)vs.Ontario KeyFindings(cont’d):OsteoarthritisPrevalenceratesbyneighbourhoodincomequintile(2006/07)Attheprovinciallevel,prevalenceratesincreasedasneighbourhoodincomeleveldecreased.AmongtheLHINs,prevalenceratesinthemiddleincomequintiles(Q2–Q4)oftenhadoverlappingconfidenceintervals;however,ineveryLHIN(excepttheNorthWestLHIN),prevalenceratesinthelowestincomequintile(Q1)weresignificantlyhigherthanthoseinthehighestincomequintile(Q5). Age-andsex-adjustedprevalencerateofosteoarthritisper100Ontariansaged20yearsandolder,byneighbourhoodincomequintile*,2006/07 Age-andsex-adjustedprevalencerateofosteoarthritisper100Ontariansaged20yearsandolder,byneighbourhoodincomequintile*,2006/07LHIN1(ErieSt.Clair)vs.Ontario Ischemicheartdisease(IHD)Heartproblemscausedbythenarrowingofheartarteries,leadingtoareductioninbloodflowandoxygentotheheartmuscle;termoftenusedinterchangeablywith“coronaryarterydisease”and“coronaryheartdisease”.Riskincreaseswithage,smoking,highcholesterollevels,highbloodpressure,obesity,diabetesandfamilyhistoryofcertainheartconditions.IHDcanbepresentwithoutsymptoms(silentischemia),butmoreoftencauseschestpain(anginapectoris).stable(i.e.,occursunderpredictablecircumstances,suchasphysicalexertionorstress,andsubsideswithmedicationorrest)unstable(i.e.,suddenonsetbecomingincreasinglyworse;canbeawarningsignofheartattack)IndividualswithIHDmayhavehadpreviousheartattack(oldmyocardialinfarction).Treatmentinvolvesuseofmedication,surgeryandlifestylechanges. KeyFindings:Ischemicheartdisease(IHD)Overallprevalencerates(2006/07)In2006/07,prevalenceratesvariedacrossLHINsLessthanhalfofLHINshadoverallprevalencerateswithin10%oftheOntariorate(6.2per100persons).OverallrateintheCentralEastLHIN(7.8per100persons)was66%higherthantheoverallrateintheWaterlooWellingtonLHIN(4.7per100persons). Age-andsex-adjustedprevalencerateofischemicheartdisease(IHD)per100Ontariansaged20yearsandolder,2006/07ByLocalHealthIntegrationNetwork(LHIN)inOntario Age-andsex-adjustedprevalencerateofischemicheartdisease(IHD)per100Ontariansaged20yearsandolder,bysub-LHINplanningarea,2006/07LHIN1(ErieSt.Clair)vs.Ontario KeyFindings(cont’d):Ischemicheartdisease(IHD)Prevalenceratesbysexand/oragegroup(2006/07)RatesformenandwomeninOntarioincreasedwithage.Ratesincreasedtwo-tothree-foldupto75yearsofage.Prevalencerateswerehighestintheoldestagegroup(85+years) forbothmenandwomen.Forwomen,the75–84agegroup hadthehighestvolume(numberofcases);formen, volumewashighestinthe50–64agegroup.AttheprovincialandLHINlevels,after34yearsofage,menhadsignificantlyhigherratesthanwomen.Disparitybetweenmenandwomenincreasedwithagegroupsuntil50–64yearsatwhichpointthedisparitywasgreatest—ratesformenwerealmosttwiceashighasthoseforwomen;from65yearsoldandonward,thegapinratesbetweenmenandwomennarrowedthroughtoage85+years. Prevalencerateofischemicheartdisease(IHD)per100Ontariansaged20yearsandolder,bysexandagegroup,2006/07 Prevalencerateofischemicheartdisease(IHD)per100Ontariansaged20yearsandolder,bysexandagegroup,2006/07LHIN1(ErieSt.Clair)vs.Ontario Age-adjustedprevalencerateofischemicheartdisease(IHD)per100Ontariansaged20yearsandolder,bysexandsub-LHINplanningarea,2006/07LHIN1(ErieSt.Clair)vs.Ontario KeyFindings(cont’d):Ischemicheartdisease(IHD)Prevalenceratesbyneighbourhoodincomequintile(2006/07)Attheprovinciallevel,prevalenceratesincreasedasneighbourhoodincomeleveldecreased.ThroughoutallLHINs,prevalenceratesinthelowestincomequintile(Q1)weresignificantlyhigherthanthoseinthehighestincomequintile(Q5). Age-andsex-adjustedprevalencerateofischemicheartdisease(IHD)per100Ontariansaged20yearsandolder,byneighbourhoodincomequintile*,2006/07 Age-andsex-adjustedprevalencerateofischemicheartdisease(IHD)per100Ontariansaged20yearsandolder,byneighbourhoodincomequintile*,2006/07LHIN1(ErieSt.Clair)vs.Ontario ArrhythmiaAnabnormalrhythmoftheheart—eitherbeatingtooquickly(tachycardia),tooslowly(bradycardia),orirregularly.Causedbyanabnormalityinthegenerationormovementofelectricalactivitythroughtheheart.Treatmentranges:lifestylechanges,drugtherapy,implantationofapermanentpacemakeroranimplantablecardioverter-defibrillatorSomeformsofarrhythmialife-threateningifnotpromptlyandproperlytreated. KeyFindings:ArrhythmiaOverallprevalencerates(2006/07)In2006/07,littlevariationinprevalenceratesamongLHINsElevenoutof14LHINprevalencerateswerewithin10%oftheOntariorate(3.6per100persons).Highest(4.2per100persons)andlowest(3.1per100persons)rateswereobservedintheCentralandWaterlooWellingtonLHINs,respectively. Age-andsex-adjustedprevalencerateofarrhythmiaper100Ontariansaged20yearsandolder,2006/07ByLocalHealthIntegrationNetwork(LHIN)inOntario Age-andsex-adjustedprevalencerateofarrhythmiaper100Ontariansaged20yearsandolder,bysub-LHINplanningarea,2006/07LHIN1(ErieSt.Clair)vs.Ontario KeyFindings(cont’d):ArrhythmiaPrevalenceratesbysexand/oragegroup(2006/07)PrevalenceratesformenandwomeninOntarioincreasedwithage,withratesdoublingbetweenagegroups35–49,50–64,65–74and75–84years.Forbothmenandwomen,prevalencerateswerehighestintheoldestagegroup(85+years);75–84agegroup hadhighestvolume(numberofcases).AttheprovinciallevelandformostLHINs,intheyoungeragegroups(20–34,35–49),prevalenceratesofarrhythmiawereslightlyhigherinwomenthaninmen.Afterage49,however,ratesofarrhythmiainmenbecamehigherthanthoseinwomen.Greatestdisparityinratesinthe65–74agegroupwheremenhadratesthatwere34%higherthanthoseinwomen. Prevalencerateofarrhythmiaper100Ontariansaged20yearsandolder,bysexandagegroup,2006/07 Prevalencerateofarrhythmiaper100Ontariansaged20yearsandolder,bysexandagegroup,2006/07LHIN1(ErieSt.Clair)vs.Ontario Age-adjustedprevalencerateofarrhythmiaper100Ontariansaged20yearsandolder,bysexandsub-LHINplanningarea,2006/07LHIN1(ErieSt.Clair)vs.Ontario KeyFindings(cont’d):ArrhythmiaPrevalenceratesbyneighbourhoodincomequintile(2006/07)PrevalenceratesofarrhythmiaremainedsteadyacrossneighbourhoodincomequintilesinOntario–anunusualfindingbecauselowsocioeconomicstatus(SES)hastraditionallybeenconsideredariskfactorforcardiovasculardiseaseingeneral.Recentstudy1alsonotedunexpectedrelationshipbetweenatrialfibrillation(mostcommonformofarrhythmia)andSES:prevalenceofatrialfibrillationdecreasedwithdecreasingSES.Associationmightberelatedtobetterscreening(morediagnoses)forthoselivinginmoreaffluentareas,andperhapstopoorersurvivalofthosepatientswithatrialfibrillationwhoresidedinlessaffluentneighbourhoods.1MurphyNF,SimpsonCR,JhundPS,etal.Anationalsurveyoftheprevalence,incidence,primarycareburdenandtreatmentofatrialfibrillationinScotland.Heart.2007;93(5):606–612. Age-andsex-adjustedprevalencerateofarrhythmiaper100Ontariansaged20yearsandolder,byneighbourhoodincomequintile*,2006/07 Age-andsex-adjustedprevalencerateofarrhythmiaper100Ontariansaged20yearsandolder,byneighbourhoodincomequintile*,2006/07LHIN1(ErieSt.Clair)vs.Ontario ChronicObstructivePulmonaryDisease(COPD)Aslow-developingchroniclungdiseasecharacterizedbyairflowlimitationduetoairwaydamage,resultinginshortnessofbreath(dyspnea),wheezing,increasedmucusproductionandcoughing.COPDincludesbothchronicbronchitisandemphysema.MostCOPDcausedbycigarettesmoking;othercontributingcausesare:heredity,second-handsmoke,prolongedexposuretoairwayirritants(dust,chemicals,pollution)andahistoryoflunginfectionsduringchildhood.Nocure;treatmentislargelytotreatandpreventsymptomsandinvolveslifestylechanges,medication,pulmonaryrehabilitationand,insomeseverecases,surgery. KeyFindings:ChronicObstructivePulmonaryDisease(COPD)Overallprevalencerates(2006/07)In2006/07,prevalenceratesvariedamongLHINsOnly4outof14LHINrateswerewithin10%oftheOntariorate(3.6per100persons).ErieSt.ClairandNorthEastLHINshadthehighestrates(5.2per100persons),whiletheCentralWest,MississaugaHaltonandCentralLHINshadthelowestrates(2.6per100persons). Age-andsex-adjustedprevalencerateofchronicobstructivepulmonarydisease(COPD)per100Ontariansaged35yearsandolder,2006/07ByLocalHealthIntegrationNetwork(LHIN)inOntario Age-andsex-adjustedprevalencerateofchronicobstructivepulmonarydisease(COPD)per100Ontariansaged35yearsandolder,bysub-LHINplanningarea,2006/07LHIN1(ErieSt.Clair)vs.Ontario KeyFindings(cont’d):ChronicObstructivePulmonaryDisease(COPD)Prevalenceratesbysexand/oragegroup(2006/07)PrevalenceratesformenandwomeninOntarioincreasedwithage,withratesincreasingtwo-tothree-foldbetween35–74yearsofage.Forbothmenandwomen,prevalencerateswerehighestintheoldestagegroup(85+years);50–64 agegrouphadhighestvolume(numberofcases).Attheprovinciallevel,afterage64,prevalenceratesweremarkedlyhigherinmenthaninwomen;thisdisparityincreasedwithage.AttheLHINlevel,prevalenceratestendedtobesimilarinmanyLHINsbetweenmenandwomenuptoage64,afterwhichratesconsistentlyfollowedOntarioleveltrends(i.e.,rateshigherinmenvs.women,disparityincreasingwithage). Prevalencerateofchronicobstructivepulmonarydisease(COPD)per100Ontariansaged35yearsandolder,bysexandagegroup,2006/07 Prevalencerateofchronicobstructivepulmonarydisease(COPD)per100Ontariansaged35yearsandolder,bysexandagegroup,2006/07LHIN1(ErieSt.Clair)vs.Ontario Age-adjustedprevalencerateofchronicobstructivepulmonarydisease(COPD)per100Ontariansaged35yearsandolder,bysexandsub-LHINplanningarea,2006/07LHIN1(ErieSt.Clair)vs.Ontario KeyFindings(cont’d):ChronicObstructivePulmonaryDisease(COPD)Prevalenceratesbyneighbourhoodincomequintile(2006/07)Attheprovinciallevel,prevalenceratesofCOPDincreasedasneighbourhoodincomeleveldecreased;thisassociationwasalsoquiteconsistentattheLHINlevel. Age-andsex-adjustedprevalencerateofchronicobstructivepulmonarydisease(COPD)per100Ontariansaged35yearsandolder,byneighbourhoodincomequintile*,2006/07 Age-andsex-adjustedprevalencerateofchronicobstructivepulmonarydisease(COPD)per100Ontariansaged35yearsandolder,byneighbourhoodincomequintile*,2006/07LHIN1(ErieSt.Clair)vs.Ontario KeyFindings(cont’d):ChronicObstructivePulmonaryDisease(COPD)InterpretativecautionforCOPD1,2COPDbelievedunder-diagnosedinprimarycare,especiallyinyoungeragegroups(lessthan60yearsold).DevelopmentofCOPDissubtleyetgraduallycumulative.Individualmaysatisfyrespiratoryfunctioncriteriafordiagnosis(e.g.,spirometry)beforecomplainingofnoticeablesymptoms(e.g.,wheezing).Inarecentstudy,closetohalfthepopulationofgeneralpracticepatientsathighriskforCOPDhadadiagnosisofCOPDapproximatelytwo-thirdsofthemwerenewlydiagnosedthroughacase-findingprogramme(i.e.,spirometrictesting)vs.throughcomplaintofnoticeablesymptoms(e.g.,wheezing).1UpshurREG,WangL,LuoJ,MaatenS,LeongA.Primarycareforrespiratorydiseases.In:JaakkimainenL,UpshurR,Klein-GeltinkJE,LeongA,MaatenS,SchultzSE,WangL,editors.PrimaryCareinOntario:ICESAtlas.Toronto:InstituteforClinicalEvaluativeSciences;2006.2VandevoordeJ,VerbanckS,GijsselsL,etal.EarlydetectionofCOPD:acasefindingstudyingeneralpractice.RespirMed.2007;101(3):525–530. CerebrovascularDisease(includingstroke)Encompassesbroadgroupingofbraindysfunctionsrelatedtobleedingin,orlackofoxygento,thebrain.Acutestrokeisthemostcommoncerebrovasculardisease.Otherconditions(e.g.,asymptomaticnarrowingofbloodvessels,subduralhematoma,latesequalaeofstroke)alsoincludedinthisgroupingofdysfunctions.Strokeoccurswhenthebloodflowtothebrainisinterrupted;ifbloodflowisstoppedformorethanseveralseconds,deathtobraincellscanoccur,causingpermanentdamage.Themajorityofstrokesareischemic,whereabloodclotblocksorplugsabloodvesselinthebrain.Strokescanalsobehemorrhagic,whereabloodvesselmaybreakandbleedintothebrain.Ifthebloodsupplytothebrainisonlybrieflyinterrupted,itisreferredtoasatransientischemicattack(TIAor“mini-stroke”). KeyFindings:CerebrovascularDisease(includingstroke)Overallprevalencerates(2006/07)In2006/07,modestvariationinprevalenceratesamongLHINsEightoutof14LHINprevalencerateswerewithin10%oftheOntariorate(1.9per100persons).SouthEastLHINhadthehighestrate(2.5per100persons),whiletheMississaugaHaltonandCentralLHINshadthelowestrates(1.6per100persons). Age-andsex-adjustedprevalencerateofcerebrovasculardiseaseper100Ontariansaged20yearsandolder,2006/07ByLocalHealthIntegrationNetwork(LHIN)inOntario Age-andsex-adjustedprevalencerateofcerebrovasculardiseaseper100Ontariansaged20yearsandolder,bysub-LHINplanningarea,2006/07LHIN1(ErieSt.Clair)vs.Ontario KeyFindings(cont’d):CerebrovascularDisease(includingstroke)Prevalenceratesbysexand/oragegroup(2006/07)PrevalenceratesformenandwomeninOntarioincreasedwithage.Forbothmenandwomen,prevalencerateswerehighestintheoldest agegroup(85+years);75–84agegroup hadhighestvolume(numberofcases).AttheprovincialandLHINlevels,prevalencerateswereslightlyhigherinmenthaninwomenforthose50yearsandolder;forthoseyoungerthan50yearsofage,ratesweresimilar. Prevalencerateofcerebrovasculardiseaseper100Ontariansaged20yearsandolder,bysexandagegroup,2006/07 Prevalencerateofcerebrovasculardiseaseper100Ontariansaged20yearsandolder,bysexandagegroup,2006/07LHIN1(ErieSt.Clair)vs.Ontario Age-adjustedprevalencerateofcerebrovasculardiseaseper100Ontariansaged20yearsandolder,bysexandsub-LHINplanningarea,2006/07LHIN1(ErieSt.Clair)vs.Ontario KeyFindings(cont’d):CerebrovascularDisease(includingstroke)Prevalenceratesbyneighbourhoodincomequintile(2006/07)Attheprovinciallevel,prevalenceratesincreasedasneighbourhoodincomeleveldecreased;thisassociationwasnotobservedinalltheLHINs,althoughformostoftheLHINs,prevalenceratesinthelowestincomequintile(Q1)weresignificantlyhigherthanthoseinthehighestincomequintile(Q5). Age-andsex-adjustedprevalencerateofcerebrovasculardiseaseper100Ontariansaged20yearsandolder,byneighbourhoodincomequintile*,2006/07 Age-andsex-adjustedprevalencerateofcerebrovasculardiseaseper100Ontariansaged20yearsandolder,byneighbourhoodincomequintile*,2006/07LHIN1(ErieSt.Clair)vs.Ontario InterpretativeCautions:OntarioHealthInsurancePlan(OHIP)physicianbillingsandhospitaldischargeabstracts(DAD)usedtoidentify“treated”prevalence.Somepatientvisitsnotcapturedusingthesesources(e.g.,visitstocommunityhealthcentres[CHCs]forwhich“shadowbillings”arenotsubmittedtoOHIP);however,CHCsgenerallyeachcontainonlyasmallnumberoffull-timeequivalentphysicians,soforthisstudyOHIPbillingsofferedarobustmeasureofprevalencerates.OHIPbillingslinkedtoRPDBderivedenominatorsforratesRPDBcontainsanumberofoutdatedaddressesandlosesaccuracyatextremesofage;nonetheless,ICES-linkedRPDBprovidesacceptablepopulationestimates.ACGsoftwarerequiredRPDB-derivedpopulationcohort.InflatedpopulationestimatesfromRPDB(comparedtocensus)insomelocationsmayleadtounderestimationoftrueprevalence.Prevalenceratesbaseduponresidentiallocationsofpatients,notlocationswherepatientsaccesshealthservices. InterpretativeCautions(cont’d):Comparisonofprevalencerateswithotherstudiesmaynotbeappropriateduetodifferencesinmethodology,forexample:Differentdatasources(e.g.,CanadianCommunityHealthSurvey[CCHS]datavs.administrativedata)Differentstandardpopulations(e.g.,Ontario2001vs.Canada1991)Differentdiseasegroupings(differentICDcodesassignedtoaparticulardisease)Eachapproach,withaccompanyingstrengthsandlimitationsdependingonthechroniccondition,shouldbetakenintoaccountformorecomprehensivepictureoftheburdenofillness.Cautionshouldbeusedwheninterpretingdataatthesub-LHINlevel.Smallerpopulationsandresultingcasevolumeswillexperiencegreaterratefluctuation.Referencetoconfidenceintervalsshouldbemadetoassistwithinterpretation.