Prevalence of Asthma, COPD,
Diabetes, and Hypertension in
Saskatchewan, 2010/11
May 2013 Summary: This snapshot report highlights the age and sex profile and regional variations for four chronic diseases (asthma, COPD, diabetes and high blood pressure) in Saskatchewan. Purpose
The purpose of this report is to present
prevalence information for four chronic diseases in Saskatchewan in the 2010/11 fiscal
year: asthma, chronic obstructive pulmonary
disease (COPD), diabetes, and hypertension.
Each disease is characterized by sex and
age-specific prevalence at the provincial level,
and also provides age-standardized prevalence estimates for comparison of disease
burden in each regional health authority.
Prevalence Trends and Co-morbidity
2010/11.
Prevalence provides an estimate of the importance and burden of disease at a given time
and is influenced by both incidence and dura-  COPD had a net increase of 1901 cases per
Purpose…..……………….……..1 tion of a disease. Estimated prevalence trends
year to more than 54,000 cases in
Prevalence Trends and Co‐
morbidity…………….........….1 are generally increasing because there are
2010/11.
more
new
cases
identified
than
there
are
Asthma…………………….……..2 cases lost to death or follow-up. For the ten
 Diabetes had a net increase of 2920 cases
COPD...……………...…...….....3 years between 2001/02 and 2010/11, the net
per year to more than 75,000 cases in
Diabetes……………...……......4 prevalence trends for the four conditions in
2010/11.
Saskatchewan
were
as
follows:
Hypertension …...…………...5  Hypertension had a net increase of 7007
Summary/Conclusion……..6 cases per year to about 213,000 cases in
 Asthma had a net increase of 3969 cases
Technical Notes …...…….….6 2010/11.
per year to more than 113,000 cases in
In this issue: Prepared by: Table 1: Co-prevalence among select chronic conditions.
Epidemiology and Research Unit, Population Health Branch, Saskatchewan Ministry of Health Number with Condition
113169
Proportion with Asthma
100%
Proportion with COPD
33.1%
100%
Contact: Proportion with Diabetes
7.4%
Val Mann, PhD Chief Population Health Epidemiologist, Population Health Branch, Saskatchewan Ministry of Health Proportion with Hypertension
30.1%
Email: [email protected] Asthma
Diabetes
Hypertension
54251
75159
212729
Crude
Population
Prevalence
27.5%
11.1%
9.9%
10.3%
18.0%
16.3%
9.4%
23.7%
100%
24.9%
6.8%
62.5%
71.3%
100%
26.2%
COPD
Individuals may have more than one chronic
 Diabetes co-prevalence is elevated among
disease, and co-morbidity among chronic disCOPD and Hypertension cases.
eases has important implications for primary
care and disease management. Table 1 shows  Hypertension co-prevalence is elevated
co-prevalence of the four selected chronic disamong COPD and particularly among diabeeases, which can be compared to the overall
tes cases.
proportion of each condition in the population.
Elevated co-prevalence of chronic conditions
 COPD has elevated co-prevalence among all may be the result of shared risk factors such
other three chronic diseases, compared to
as smoking and obesity, or of physiological
the overall COPD prevalence in the populacharacteristics that make diseases risk factors
tion.
for each other.
 There is elevated co-prevalence between the
two respiratory conditions: Asthma and
COPD.
Page 1 of 6
Asthma
Figure1:1:Asthma
Asthma(all
(allages
ages)
- Age-specificPrevalence,
Prevalence,Saskatchewan,
Saskatchewan,2010/11
2010/11
Figure
): Age-Specific
Management of asthma
includes identification and
avoidance of triggers that
cause asthma attacks, as
well as use of quick-relief
medications to treat acute
symptoms and long-term
control medications to
prevent further
exacerbation.
For surveillance purposes,
the asthma case definition
requires that an individual
must have EITHER:
•
•
One or more
inpatient hospital
separations with a
diagnosis of ICD-9
code 493 or ICD-10CA codes J45, J46 in
any field of the
hospital separation
records; OR
Two or more
physician claims with
a diagnosis of ICD-9
493 within two years.
The asthma case definition
applies to all ages.
30
25
Percentage (%)
Asthma is a chronic
inflammatory disease of
the airways that is
characterized by wheezing,
coughing, chest tightness,
and shortness of breath. It
is thought to be caused by
a combination of genetic
and environmental factors
such as exposure to
allergens, tobacco smoke,
and viral respiratory
infections.
20
15
10
5
0
<1
1-4
5-9
Females
1.0
6.4
13.0
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
16.7
15.5
12.7
10.2
9.3
9.2
9.0
8.9
8.9
9.0
9.6
9.6
10.1
9.7
9.4
85+
8.2
Males
1.8
9.9
18.9
24.1
19.9
14.2
9.0
7.3
6.5
6.3
5.9
5.8
5.9
5.9
6.5
7.3
8.4
8.1
8.8
Total
1.4
8.2
16.0
20.5
17.7
13.5
9.6
8.2
7.8
7.6
7.4
7.3
7.4
7.8
8.1
8.7
9.1
8.8
8.4
• Asthma is most prevalent in childhood with
• Age-specific asthma prevalence among Sas-
about half of the cases (48%) being younger
than 25 years of age, and a significantly
higher prevalence among males.
katchewan residents older than 25 years of
age is relatively stable around 9.3% for females and 8.2% for males.
• The highest asthma prevalence is in the 10 to
14 years age group, with about 20% of children having met the case definition.
Figure 2: Asthma Age Standardized Prevalence 2010/11
Figure 2: Asthma (all ages) - Age-standardized Prevalence by SK Health Region, 2010/11
Saskatchew an
Athabasca
2.5
Keewatin Yatthé
4.3
Mamawetan Churchill River
5.8
Prairie North
7.6
Kelsey Trail
8.4
Cypress
9.2
Heartland
9.8
Saskatoon
9.9
Prince Albert Parkland
10.4
Saskatchewan
10.5
Sun Country
10.8
Sunrise
11.0
Five Hills
11.8
Regina Qu'Appelle
13.3
0
2
4
6
8
10
12
14
16
Percentage (%)
• Asthma prevalence is significantly lower than • Asthma prevalence is significantly higher
Saskatchewan in the Athabasca, Keewatin
Yatthé, Mamawetan Churchill River, Prairie
North, Kelsey Trail, Cypress, Heartland, and
Saskatoon health regions.
Page 2 of 6
than Saskatchewan in the Sunrise, Five
Hills, and Regina Qu'Appelle health regions.
Chronic Obstructive Pulmonary
Disease (COPD)
Figure 3: COPD (ages
35 and
older):
Age-Specific
Prevalence,
Saskatchewan,
(ages 35
years
and older)
- Age-specific
Prevalence,
Saskatchewan, 2010/11
2010/11
Chronic bronchitis and
emphysema, together with
similar respiratory illnesses,
are collectively known as
chronic obstructive
pulmonary disease (COPD).
COPD is characterized by
progressive and chronic
airflow limitation that is not
fully reversible and is most
commonly diagnosed in
individuals 35 years of age
and older. COPD is largely
preventable as the majority
of cases are caused by
smoking.
40
35
Percentage (%)
30
25
20
15
10
5
0
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Females
0.7
2.6
4.5
6.4
8.0
11.2
14.7
17.3
19.1
20.2
21.0
Males
0.7
2.2
3.8
6.2
8.1
11.8
16.3
20.6
25.0
28.3
32.2
Total
0.7
2.4
4.1
6.3
8.0
11.5
15.5
18.9
21.8
23.7
24.7
case definition.
• Age-specific COPD prevalence increases
gradually until about age 59 with a slightly
higher female prevalence in the 45-49 years
age group.
• By age 85 years, about one-quarter of Saskatchewan residents have met the COPD
• COPD prevalence increases with a steeper
gradient among older males, where male
prevalence is significantly higher than female among Saskatchewan residents aged
65 years and older.
Important management
strategies are smoking
cessation, vaccinations for
respiratory organisms,
rehabilitation, and drug
therapy (often using
inhalers).
For surveillance purposes,
the COPD case definition
requires that an individual
must have EITHER:
•
One or more
inpatient hospital
separations with a
diagnostic code ICD-9
491, 492, 496 or ICD10-CA J41-J44 in any
field of the hospital
separation records;
OR
•
One or more
physician claims with
a diagnostic code ICD9 491, 492, 496
Figure
4:4:COPD
andolder)
older)
- Age-standardized
Prevalence
Figure
COPD(ages
(ages35
35 years
years and
Age
Standardized Prevalence
2010/11by SK Health Region, 2010/11
Saskatchew an
Saskatoon
6.6
Cypress
7.0
Sun Country
7.3
Saskatchewan
8.2
Kelsey Trail
8.3
Regina Qu'Appelle
8.5
Heartland
8.8
Sunrise
9.0
Five Hills
9.4
Mamawetan Churchill River
9.7
Prairie North
9.7
Prince Albert Parkland
10.8
Athabasca
12.8
Keewatin Yatthé
13.7
0
The COPD case definition
applies to individuals 35
years of age and older.
2
4
6
• COPD prevalence is significantly lower than
Saskatchewan in the Saskatoon, Cypress,
and Sun Country health regions.
8
10
12
14
16
18
Percentage (%)
Heartland, Sunrise, Five Hills, Mamawetan
Churchill River, Prairie North, Prince Albert
Parkland, Athabasca, and Keewatin Yatthé
health regions.
• COPD prevalence is significantly higher than
Saskatchewan in the Regina Qu'Appelle,
Page 3 of 6
Diabetes
Diabetes increases the risk
of heart disease and
stroke, blindness, kidney
disease, peripheral nerve
problems, and amputation.
These risks may be reduced
by controlling blood sugar
with a healthy diet,
exercise, weight loss and
medications.
Figure
5: Diabetes
yearAge-Specific
and older)Prevalence,
- Age-specific
Prevalence,
Saskatchewan,
Figure
5: Diabetes
(ages(age
1 and1older)
Saskatchewan,
2010/11
30
25
20
15
10
5
0
For surveillance purposes,
the diabetes case definition
requires that an individual
must have EITHER:
• One or more inpatient
hospital separations with
an ICD-9 code 250 or an
equivalent ICD-10-CA
code E10 to E14,
selected in any field of
the hospital separation
records; OR
• Two or more physician
claims with a diagnostic
code ICD-9 250 within
two years.
These diagnostic codes
include both type 1 and
type 2 diabetes.
The case definition does
not include temporary
gestational diabetes.
Therefore, the case criteria
exclude females aged 10 to
54 diagnosed with diabetes
120 days preceding or 180
days after any pregnancyrelated hospital visit (as
identified by a set of
obstetric diagnostic codes).
The diabetes case
definition applies to
individuals one year of age
and older.
2010/11
35
Percentage (%)
Diabetes is characterized
by the body’s inability to
sufficiently produce and/or
use insulin – a hormone
produced by the pancreas
that assists with the
conversion of glucose
(sugar) into energy.
1-4
5-9
10-14
80-84
85+
Females
0.1
0.2
0.4
15-19 20-24
0.6
0.7
25-29 30-34
1.3
2.2
35-39 40-44
3.4
4.8
6.1
7.9
10.7
14.7
18.0
20.5
21.1
21.8
19.8
Males
0.1
0.2
0.5
0.6
0.7
1.1
1.7
3.1
4.9
6.8
9.8
13.5
18.8
23.8
27.2
28.3
28.5
24.6
Total
0.1
0.2
0.4
0.6
0.7
1.2
1.9
3.3
4.9
6.5
8.8
12.1
16.8
20.9
23.7
24.4
24.7
21.4
• Age-specific diabetes prevalence increases
gradually until about age 44 years with a
slightly higher female prevalence in the 3034 years age group.
45-49
50-54 55-59
60-64 65-69
70-74 75-79
• Diabetes prevalence in 2010/11 was highest
for Saskatchewan residents aged 75 to 84
years, at almost 20% for women and 25% for
men.
• At ages 45 years and older, diabetes preva-
• Past age 84 years, a decrease in prevalence
lence in men is starting to be significantly
higher than in women.
occurs possibly due to reduced life expectancy of people with diabetes.
Figure
(age1 1
year
and
- Age-standardized
Prevalence by SK Health Region,
Figure6:
6: Diabetes
Diabetes (ages
and
older)
Ageolder)
Standardized
Prevalence 2010/11
Saskatchewan
Sun Country
5.0
Saskatoon
5.1
Cypress
5.1
Heartland
5.3
Sunrise
5.8
Saskatchewan
5.8
Regina Qu'Appelle
5.9
Five Hills
6.0
Athabasca
6.1
Prairie North
6.7
Prince Albert Parkland
6.7
Kelsey Trail
6.9
Keewatin Yatthé
9.2
Mamawetan Churchill River
10.2
0
2
4
6
8
10
12
Percentage (% )
• Diabetes prevalence is significantly lower
than Saskatchewan in the Sun Country,
Saskatoon, Cypress, and Heartland health
regions.
Page 4 of 6
• Diabetes prevalence is significantly higher
than Saskatchewan in the Prairie North,
Prince Albert Parkland, Kelsey Trail, Keewatin Yatthé, and Mamawetan Churchill
River health regions.
Hypertension
Figure 7:7:
Hypertension
- 2012(ages
(ages20
20 and
older)
Provincial
Prevalence,
SK, 2010/11
Figure
Hypertension
years
and
older) -Age-Specific
Age-specific
Prevalence,
Saskatchewan, 2010/11
Hypertension occurs when
systemic arterial blood
pressure is consistently
high for long periods of
time.
100
90
80
If left untreated,
hypertension can increase
the risk of stroke, coronary
heart disease, dementia,
heart and kidney failure.
Percentage (%)
70
60
50
40
People with hypertension
may reduce their risk of
complications by
controlling blood pressure
with a healthy diet,
exercise, weight loss,
smoking cessation,
reducing alcohol intake,
and anti-hypertensive
medications.
30
20
10
0
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Females
0.5
1.6
3.5
6.4
10.4
16.3
25.0
35.2
47.8
59.4
68.3
75.7
81.6
85.1
Males
0.7
2.1
4.3
7.6
11.8
17.8
25.6
35.6
47.0
56.8
65.8
71.7
76.2
78.2
Total
0.6
1.9
3.9
7.1
11.1
17.1
25.3
35.4
47.4
58.1
67.1
73.9
79.3
82.8
• Hypertension prevalence increases with age
and more than half of the population older
than 65 years of age met the hypertension
case definition.
• More than 80% of Saskatchewan residents
• Male age-specific hypertension prevalence is
significantly higher then female prevalence
between the ages of 20 and 49, whereas female prevalence is higher than male among
Saskatchewan residents aged 75 years and
older.
aged 85 years and older has met the hypertension case definition.
Figure 8: Hypertension (ages 20 years and older) - Age-standardized Prevalence by SK Health Region,
Figure2010/11
8: Hypertension (ages 20 and older) Age Standardized Prevalence 2010/11
Saskatchew an
Athabasca
14.0
Saskatoon
19.3
Mamawetan Churchill River
21.2
Cypress
21.3
Prince Albert Parkland
21.5
Saskatchewan
21.5
Regina Qu'Appelle
21.9
Kelsey Trail
22.1
Keewatin Yatthé
22.5
Sun Country
22.4
Heartland
22.7
Five Hills
23.3
Prairie North
23.8
Sunrise
24.5
0
For surveillance purposes,
the hypertension case
definition requires that an
individual must have
EITHER:
• One or more inpatient
hospital separations with
a diagnosis of ICD-9
codes 401,402, 403, 404,
405 or ICD-10-CA codes
I10, I11, I12, I13, I15,
selected in any field of
the hospital separation
records; OR
• Two or more physician
claims with a diagnostic
code ICD-9 401-405
within two years.
These diagnostic codes
include both essential and
secondary hypertension.
The case definition does
not include temporary
pregnancy-induced
hypertension. Therefore,
the case criteria exclude
females aged 10 to 54
diagnosed with
hypertension 120 days
preceding or 180 days after
any pregnancy-related
hospital visit (as identified
by a set of obstetric
diagnostic codes).
5
10
15
20
25
30
Percentage (%)
• Hypertension prevalence is significantly lower
than Saskatchewan in the Athabasca and
Saskatoon health regions.
• Hypertension prevalence is significantly
higher than Saskatchewan in the Regina
Qu'Appelle, Kelsey Trail, Sun Country, Heartland, Five Hills, Prairie North, and Sunrise
health regions.
Page 5 of 6
The hypertension case
definition applies to
individuals 20 year of age
and older.
Summary/Conclusion
• Three of the four chronic diseases (COPD,
diabetes, and hypertension) are characterized
by increased prevalence at older ages with a
substantial proportion of Saskatchewan residents affected and considerable coprevalence among the three. Consequently,
there will be an increasing burden and complexity of chronic disease in an aging society.
• Differences between males and females are
not consistent for the four diseases: male
prevalence is higher for COPD, diabetes, and
childhood/adolescent asthma, while female
prevalence is higher for adult asthma and
hypertension among the elderly.
• There are few consistent regional differences
among the four diseases: Saskatoon Health
Region had significantly lower prevalence of
all four conditions compared to the Province,
and Cypress had lower prevalence of three
conditions. On the other hand, Regina
Qu'Appelle, Sunrise, Prairie North, and Five
Hills Health Regions had significantly higher
prevalence of three conditions than Saskatchewan. However, differences in prevalence are generally difficult to interpret because prevalence may be influenced by physician billing practices, disease risk factors
and health determinants, screening mechanisms in place, and approaches to care/
disease management that affect survival and
duration of the disease.
Technical Notes
Method:
• To facilitate comparisons, 95% confidence
Chronic disease estimates are based on the
case definitions and infrastructure of the Canadian Chronic Disease Surveillance System
(CCDSS), with support of the Public Health
Agency of Canada. This method is based on
linkage of administrative data sources including:
• Person Health Registry System: includes all
residents eligible for Saskatchewan Health
benefits and provides the annual population
base, demographic, and coverage information.
• Hospital services: includes data on inpatient
separations and day surgeries for patients
treated in hospitals. Out-of-province hospital
separations for Saskatchewan health beneficiaries are also captured.
• Medical services: includes physician and
intervals (CIs) of all age-standardized and
age-specific rates were calculated when the
rate is greater than zero. The CI includes
the true value for the estimated rate 19
times out of 20. A prevalence difference was
considered statistically significant if there
was no overlap of confidence intervals.
Limitations:
• Administrative data do not capture undiagnosed chronic diseases.
• Persons with physician diagnosed chronic
conditions may be excluded if they receive
their care in a setting where services are not
billed on a fee-for-service basis. Services
delivered by physicians in salaried or contractual arrangements may or may not be
captured if service information is not submitted consistently through “shadow billing”.
nurse practitioner service claims.
Ascertainment of chronic disease cases in the
CCDSS starts with the 1995/96 fiscal year.
Calculations:
• Case ascertainment is sensitive to changing
diagnostic criteria and to changes in billing
practices. These changes may cause significant short-term fluctuations in incidence
estimates.
• Age standardization allows comparisons to
be made among regions that have populations with different age distributions or comparisons over time by accounting for an aging population. To adjust for differences in
population age distributions across regions
and the resulting effect on rates, the rates
are age-adjusted using the 1991 Canadian
population as a reference. Adjustment is
done via the direct method, using five-year
age groups to age 85 years and older.
Page 6 of 6
• Any system which tracks lifelong diseases
over many years on an individual basis will
tend to accumulate false positives. This is
because a case, once identified, is carried
forward from year to year. Even if false positives are extremely rare, they will still inevitably comprise an increasing proportion of
reported cases over time.