Key Findings from the HNHB LHIN Health Atlas

Key findings of the Health Atlas are divided into four sections:

  1. Population characteristics and determinants of health
  2. Population health status
  3. Health system utilization and capacity
  4. Health care system performance

Population Characteristics and Determinants of Health

Demographic and Socio-Economic Characteristics

  • The HNHB LHIN covers 6,600 km2 and encompasses Brant, Burlington, Haldimand, Hamilton, Niagara and most of Norfolk.
  • The HNHB LHIN is home to approximately 1.4 million people, the third largest population of all 14 LHINs in Ontario. Over 70% of the population in the HNHB LHIN resides in Hamilton and Niagara. First Nations co-located in the HNHB LHIN represent approximately 1% of the population; the third largest population after the North East and North West LHIN’s.
  • Between 2009 and 2019, the HNHB LHIN population is projected to grow by about 9.6% to over 1.5 million people. This growth rate is is slower than the Ontario rate of 12.1%. Growth within the HNHB LHIN varies by community. Burlington is projected to grow the fastest and Niagara is projected to grow the slowest.
  • The HNHB LHIN’s population is aging. Over the next 10 years, the largest population growth will be among people ages 65-74 (growing by 43.5%) and over 84 (growing by 28.5%).
  • Over 200,000 seniors live in the HNHB LHIN which is the largest number of seniors of all Ontario LHINs. As of 2009, seniors 65 years of age and older represent 15.7% of the total HNHB LHIN population, compared to 13.6% for all of Ontario. Based on projections for 2019, seniors will represent 18.7% of the HNHB LHIN population compared to 16.7% for the province as a whole.
  • The age structure of the LHIN population varies by community. For example, seniors (over the age of 65) account for approximately 6.1% of the Aboriginal population in the HNHB LHIN compared to 10% of the total population of West Lincoln, 21% of Port Colborne, 24% of Niagara-on-the-Lake, and 15.7% of the total population of the HNHB LHIN.The HNHB LHIN has a diverse population. For 18% of HNHB residents, English or French is not their first language. Francophones, First Nations, and urban and rural Aboriginal people are recognized populations in the HNHB LHIN. There are two reserves within the HNHB LHIN, Six Nations and Mississaugas of the New Credit. Approximately half of the First Nations population co-located in the HNHB LHIN live on reserve. The age structure of the on reserve population is younger than off reserve. According to data from Indian and Northern Affairs Canada, the age distribution of Aboriginal peoples who live on reserve is considerably younger. Seniors account for approximately 6.1% of the Aboriginal population who live on reserve in First Nations co-located in the HNHB LHIN compared to 12.7% for Off Reserve and 15.8% for LHIN as a whole.
  • Compared to the Ontario average, the HNHB LHIN has higher percentages of lone parent families and seniors living alone and a lower percent of adults with postsecondary education. Socio-economic characteristics vary across the LHIN. For example, Hamilton has 18.1% of its population living in low income which is considerably higher than the 8.0% for Haldimand. In Burlington 63.4% of the population has completed post-secondary education compared to 48.1% for Halidmand and Norfolk.

Lifestyle Behaviours and Preventive Care

  • Relative to the province, more people in the HNHB LHIN smoke daily or occasionally, drink heavily, and are obese. In 2007, 25.1% of residents of the HNHB LHIN were daily or occasional smokers, 27.0% consumed five or more drinks on one occasion, at least once a month within the last year, and 52.8% were active or moderately active. In addition, 32.2% of the adult HNHB LHIN population was considered overweight and 19.3% were obese.
  • Differences in lifestyle behaviours are seen for men and women. As compared to the province, the HNHB LHIN has a significantly higher percent of:
    • women who are daily or occasional smokers
    • both men and women who drink heavily
    • men who are physically active
    • women who are obese
  • Within the last three years, 71.7% of women in the HNHB LHIN had a pap smear (for cervical cancer screening), 54.5% of women received a routine mammogram in the previous two years, and 36.9% had a flu shot in the past year. None of these preventive health indicators are significantly different from Ontario as a whole.

Population Health Status

Well-being, Personal Resources, Health Conditions, and Human Function

  • Similar to the provincial rates, over 60% of HNHB residents rate their health as ‘excellent’ or ‘very good’.
  • A significantly higher percentage of HNHB LHIN residents reported they are limited in activities because of a physical or mental condition, or health problem compared to the province.
  • HNHB LHIN residents have significantly higher rates of arthritis/rheumatism, high blood pressure, and asthma compared to the province as a whole. Diabetes rates are slightly, but not significantly, lower than provincial rates.
  • Differences in chronic conditions are seen for men and women. As compared to the province, the HNHB LHIN has a significantly higher percent of:
    • both men and women who have arthritis/rheumatism
    • women who have high blood pressure
    • men who have asthma
  • In the HNHB LHIN as of 2006, the rate of low birth weight babies was 5.97 per 100 live births compared to 6.10 per 100 live births for Ontario.

Deaths

  • As of 2005, life expectancy at birth was 79.9 years in the HNHB LHIN compared to 80.7 years for the province. Life expectancy is longer for females (81.9 years for females and 77.7 years for males in the HNHB LHIN).
  • The overall death rate for all causes of mortality is significantly higher in the HNHB LHIN compared to the province as a whole. Within the LHIN, the death rate in Brant is significantly higher than the HNHB LHIN rate and the death rate in Burlington is significantly lower.
  • The infant mortality rate in the HNHB LHIN is 4.98 per 1,000 live births which is lower than the provincial rate of 5.40 per 1,000 live births (2003-2005 average).
  • Potential years of life lost are useful for measuring the number of years of life “lost” from deaths that occur “prematurely” (i.e., before age 75). In 2005, there were over 66,000 potential years of life lost among residents of the HNHB LHIN. Heart disease, lung cancer, suicide, and motor vehicle collisions account for the most potential years of life lost. The rate of potential years of life lost is higher in the HNHB LHIN compared to the province and variation is seen within the LHIN.

Health System Utilization and Capacity

Health Care System Utilization

  • The acute care hospitalization rate for residents of the HNHB LHIN was significantly higher than the provincial rate. In 2007-08, over 96,000 HNHB residents stayed in an acute care hospital, accounting for over 125,000 stays. The most common diagnoses responsible for acute hospitalization include childbirth and complications of pregnancy, labour and delivery, acute myocardial infarction (heart attacks), chronic obstructive pulmonary disease, and heart failure.
  • Hospital utilization patterns vary by socio-demographic characteristics. For example, seniors in the HNHB LHIN account for about 38% of acute hospital stays and represent about 16% of the population.
  • HNHB LHIN residents use hospitals within the HNHB LHIN for most of their hospital care. Overall, less than 7% of acute care hospitalizations for HNHB LHIN residents occurred at hospitals outside of the LHIN. In contrast, about 6% of acute stays at hospitals within the HNHB LHIN were from residents who did not live in the HNHB LHIN. There is variation across the LHIN. For example, in 2007-08 approximately 22% of acute hospital stays among residents of Burlington occurred at hospitals outside of the HNHB LHIN compared to 3% of Hamilton residents who were admitted to a hospital outside of the LHIN.
  • The rate of emergency department utilization is higher among residents of the HNHB LHIN compared to the province. Within the HNHB LHIN, rates of emergency department utilization vary greatly. Residents of Burlington had the lowest rate and residents of Haldimand County had the highest rate of emergency department visits.
  • There are over 590,000 visits to an emergency department among residents of the HNHB LHIN. While the number of emergency department visits has increased over the past four years, the age-adjusted rate of emergency department utilization has remained stable.
  • The greatest contributor to the higher rates of emergency department utilization by HNHB LHIN residents was the high rate of emergency department visits per population for less urgent or non-urgent cases.
  • In 2006-07, HNHB LHIN residents had 2,971 complex continuing care (CCC) admissions, the highest volume of CCC admissions among the 14 LHINs and representing 15.6% of the total CCC admissions at Ontario hospitals. The utilization rate of CCC for residents of the HNHB LHIN was well above Ontario average. In particular, the highest age-adjusted rates were for residents of Brant and Niagara.
  • In 2007-08, there were over 2,900 inpatient rehabilitation admissions among residents of the HNHB LHIN. The age-adjusted rate for HNHB LHIN residents was significantly lower than the Ontario rate. Within the HNHB LHIN, admission rates for inpatient rehabilitation vary. The lowest age-standardized rates were for residents of Niagara, Haldimand, and Norfolk.
  • Orthopedic conditions, stroke, and medically complex patients were the most common groups of rehabilitation admission. In 2007-08 among residents of the HNHB LHIN, orthopaedic conditions accounted for 39% of all inpatient rehabilitation admissions compared to 51% for the province. In contrast, stroke accounted for 16% of all inpatient rehabilitation admissions among residents of the HNHB LHIN compared to 13% for the province as a whole.
  • In 2006-07, there were over 50,000 admissions to home care among residents of the HNHB LHIN. In-home acute and in-home rehabilitation were the most common services.

Health Care System Capacity

  • There are 244 health service provider agencies in the HNHB LHIN who deliver a wide range of health services. As of June 2009, there were:
    • 10 Hospital Corporations
    • 88 Long-Term Care Homes
    • 1 Community Care Access Centre
    • 88 Community Support Services: 64 Community Support Services (CSS) Programs, 3 Acquired Brain Injury Programs, 21 Assisted Living Services Supportive Housing (ALSSH) Programs
    • 50 Community Mental Health and Substance Abuse: 18 Addictions Programs, 32 Mental Health Programs
    • 7 Community Health Centres
  • As of 2007-08, there were 3,573 hospital beds staffed and in operation within the HNHB LHIN, including: 2,127 acute, 382 mental health, 793 complex continuing care, and 271 general and specialized rehabilitation.
  • The HNHB LHIN has more long-term care beds than any other LHIN.
  • Physician-to-population ratios vary across the HNHB LHIN area. As of 2007, there were 76 family physicians per 100,000 population in the HNHB LHIN, significantly lower than the provincial rate of 85 family physicians per 100,000 population. Within the HNHB LHIN, the lowest rates are seen in Haldimand, Norfolk, and Niagara.
  • In spite of the low ratio of family physicians per population in the HNHB LHIN, according to the 2007 Canadian Community Health Survey, 92.7% of HNHB LHIN residents reported that they had a regular medical doctor. This reported rate was above the Ontario average (90.4%). According the Primary Care Access Survey, approximately 4.2% of people 16+ years in the HNHB LHIN are unattached in regards to primary care, representing approximately 47,000 people. The percent of unattached patients for the province as a whole was estimated at 7.0%.
  • With the exception of Hamilton, communities within the HNHB LHIN are designated as having family physician vacancies by the Underserviced Area Program (UAP) of the Ontario Ministry of Health and Long-Term Care. As of March 2009, there were 119 general practitioner/family physician vacancies in the LHIN with the highest number of vacancies in Niagara (81 vacancies).

Health Care System Performance

  • The HNHB LHIN uses a balanced scorecard to report on performance across four domains. These domains are cornerstones of the HNHB LHIN’s mission and vision:
    • System Integration – Focus is on measures that report how well the system is integrating (connecting) care along the continuum of clients’ interaction with the health care system.
    • Client Access and Outcomes - Focus is on measures that report clients’ abilities to access health care services in a timely manner and outcomes.
    • Financial Health and System Sustainability - Focus is on measures that report how well the health care organizations and managers of health care are managing health care resources in a fiscally prudent manor.
    • Organizational Health - Focus is on measures that report how well the health care organization is managing its internal resources (i.e., heath human resources).
  • An example of an indicator included on the HNHB LHIN scorecard is % ‘Alternate Level of Care’ (ALC) days. Following the acute phase of hospitalization a relatively large proportion of patients in the HNHB LHIN are designated ALC, compared to the provincial average. ALC days are an indicator of system integration. Many patients are waiting for a long-term care bed or another level of care such as inpatient rehabilitation (active and slow-paced) or palliative care.
  • Refer to HNHB LHIN Performance Report Card for current and additional details about health care system performance.