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about cerebrovascular disease prevalence and incidence data

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  • For each data source, information about data collection and analytical methods, limitations, the citation and additional resources can be found on the Data Sources and Methods page.

SOURCE

Original source: Institute of Clinical Evaluative Sciences (ICES)
Distributed by: Institute of Clinical Evaluative Sciences (ICES)
Cite as: Sources: Cerebrovascular Disease Database, 1996-2013. Institute for Clinical Evaluative Sciences.

METHODS

Data Collection Methods

  • ICES uses data from the following databases to make a determination of cerebrovascular disease prevalence and incidence:
    • Ontario Health Insurance Plan Claims Database (OHIP)
    • Discharge Abstract Database (DAD)
    • Registered Persons Database (RPDB)
  • The OHIP database contains approved physician claims data from inpatient, outpatient and long-term care settings for physicians in Ontario. Among other information, each record identifies the physician, the patient, the diagnosis responsible for the claim (which follows the ICD-9 coding scheme), the service provided and the date at which the service was provided.
  • The DAD summarizes the hospital discharge information of individuals receiving inpatient care (excluding hospitalizations in an adult mental health-designated bed. Each record contains demographic, clinical and administrative data regarding the hospitalized individual. The clinical information includes the diagnosis most responsible for the hospitalization (which follows the ICD-9 coding scheme before 2002 and the ICD-10 scheme from 2002 onwards), as well as comorbidities and procedures received.
  • The RPDB contains demographic information such as age, sex, health insurance eligibility and death information for anyone who has received Ontario health care coverage. It contains postal code information that is linkable to other geographic information such as public health unit.
  • The cerebrovascular disease database identifies persons aged 20 years and older in Ontario with cerebrovascular disease since 1991. It uses a previously-validated algorithm1 to identify persons with cerebrovascular disease.

Analysis Methods

  • Cerebrovascular disease cases were defined as individuals with at least one cardiovascular disease record in the DAD (diagnostic or procedure code) or two cardiovascular disease records within a one-year period in OHIP.
  • The following codes were used to define cerebrovascular disease:

    OHIP CODES

    ICD-9 (diagnostic code) ICD Code name
    432 Other and unspecified intracranial hemorrhage
    436 Acute, but ill-defined, cerebrovascular disease

    DAD

    ICD-9 ICD Code name
    430 Subarachnoid hemorrhage
    431 Intracerebral hemorrhage
    434 Occlusion of cerebral arteries
    436 Acute, but ill-defined, cerebrovascular disease

     

    ICD-10 ICD Code name
    H34.0 Retinal vascular occlusions
    H34.1 Central retinal artery occlusion
    I60.0 Subarachnoid haemorrhage from carotid siphon and bifurcation
    I60.1 Subarachnoid haemorrhage from middle cerebral artery
    I60.2 Subarachnoid haemorrhage from anterior communicating artery
    I60.3 Subarachnoid haemorrhage from posterior communicating artery
    I60.4 Subarachnoid haemorrhage from basilar artery
    I60.5 Subarachnoid haemorrhage from vertebral artery
    I60.6 Subarachnoid haemorrhage from other intracranial arteries
    I60.7 Subarachnoid haemorrhage from intracranial artery, unspecified
    I60.9 Subarachnoid haemorrhage, unspecified
    I61 Intracerebral haemorrhage
    I63.0 Cerebral infarction due to thrombosis of precerebral arteries
    I63.1 Cerebral infarction due to embolism of precerebral arteries
    I63.2 Cerebral infarction due to unspecified occlusion or stenosis of precerebral arteries
    I63.3 Cerebral infarction due to thrombosis of cerebral arteries
    I63.4 Cerebral infarction due to embolism of cerebral arteries
    I63.5 Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries
    I63.8 Other cerebral infarction
    I63.9 Cerebral infarction, unspecified
    I64 Stroke, not specified as haemorrhage or infarction

     

    CCP - Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures (pre2002) CPP Code name
    1IJ50 Dilation, coronary arteries
    1IJ57GQ Extraction, coronary arteries
    1IJ76 Bypass, coronary arteries

     

    CCP - Canadian Classification of Diagnostic, Therapeutic and Surgical interventions (2002+) CPP Code name
    48.02 Percutaneous transluminal coronary angioplasty (ptca) without mention of thrombolytic agent
    48.03 Percutaneous transluminal coronary angioplasty (ptca) with thrombolytic agent
    48.09 Other removal of coronary artery obstruction
    48.1 Bypass anastomosis for heart revascularization

  • Inclusion criteria: All individuals living in the Peel public health region with cerebrovascular disease (CVD). Individuals were identified with the disease according to CVD algorithm1 using diagnostic code information from OHIP and DAD.
  • Exclusion criteria: Individuals were excluded if they did not have an Ontario postal code or did not have contact with the Ontario health care system within the past seven years. Individuals had to be 20 years and older but less than 106 years.
  • Calculation of Prevalence: For each year, the numerator was all individuals residing in Peel region with CVD. The denominator was all individuals living in Peel according to the Ontario population estimate table. For each year (January 1 to December 31) from 1996 to 2013, the overall crude and age-sex adjusted prevalence estimates (per 1,000) were estimated. The standard population used for this calculation was the 1991 Canadian Census population.
  • Calculation of Incidence: For each year, the numerator was all individuals residing in Peel region who were newly identified in that year with CVD. The denominator was all individuals living in Peel according to the Ontario population estimate table that did not have the disease of interest (i.e. the susceptible population). For each year (January 1 to December 31) from 1996 to 2013, the overall crude and age-sex adjusted incidence estimates (per 1,000) were calculated. The standard population used for this calculation was the 1991 Canadian Census population.
  • Ontario intercensal and postcensal population estimates and projections were used to calculate prevalence and incidence rates.

LIMITATIONS

  • Currently, this data source only provides information at the Census Division (CD) or Public Health Unit (PHU) level of geography.

REFERENCES AND RESOURCES

  1. Tu K, Wang M, Young J, et al. Validity of administrative data for identifying patients who have had a stroke or transient ischemic attack using EMRALD as a reference standard. Can J Cardiol 2013; 29: 138894.


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