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![Public Health Agency of Canada (PHAC)](/web/20061211120631im_/http://www.phac-aspc.gc.ca/gfx_common/pphb.gif)
Respiratory Disease in Canada
Canadian Institute for Health Information
Canadian Lung Association
Health Canada
Statistics Canada
Foreword
Acknowledgements
Summary
List of Figures
List of Tables
Data Sources
Introduction
Chapter 2 Tobacco Use
Chapter 3 Air Quality and
Respiratory Health
Chapter 4 Asthma
Chapter 5 COPD
Chapter 6 Lung Cancer
Chapter 7 Infectious Diseases
Chapter 8 Cystic Fibrosis
Chapter 9 Respiratory Distress
Syndrome
Glossary
The purpose of Respiratory Disease in Canada is to provide ready
access to the latest national surveillance information on communicable and
chronic respiratory disease in Canada to politicians, health professionals,
the media, academics and students, and managers in government, industry, and
other organizations. While individual reports on some respiratory diseases
are available, there is no recent document that summarizes the present state
of respiratory disease in Canada. This document will serve as the starting
point for regular reporting on respiratory disease in Canada.
Respiratory Disease in Canada is a collaborative effort of the
Canadian Lung Association, Health Canada, Statistics Canada, and the Canadian
Institute for Health Information. If you would like more copies or have any
comments on the report or suggestions for future reports please contact:
Geoffroy Scott
Centre for Chronic Disease Prevention and Control
Health Canada
Jeanne-Mance Bldg., Tunney's Pasture
Ottawa, Ontario
K1A 0K9
Phone (613) 957-9429
Fax (613) 954-8286
Internet geoffroy_scott@hc-sc.gc.ca
Vicki Bryanton, Health Initiatives Working Group, Canadian Lung Association
Yue Chen, Department of Epidemiology and Community Medicine, University
of Ottawa
Helen Johanson, Statistics Canada
Kira Leeb, Canadian Institute for Health Information
Louise McRae, Centre for Chronic Disease Prevention and Control, Health
Canada
Philip Michaelson, Centre for Chronic Disease Prevention and Control, Health
Canada
Cyril Nair, Statistics Canada
Paula Stewart (Chair), Centre for Chronic Disease Prevention and Control,
Health Canada
Contributing Authors and Reviewers |
Chapter 2 |
Margaret De Groh, Centre for Chronic Disease Prevention and Control,
Health Canada; Murray Keiserman, Tobacco Control Program, Health Canada
|
Chapter 3 |
Rose Dugandzic, Dave Stieb, Barry Jessiman and Tom Furmanczyk, Air Health
Effects Division, Health Canada; acknowledgements to David Miller &
Robert Dales |
Chapter 4 |
Tony Bai, Canadian Thoracic Society; Andrea Kenney, Allergy/Asthma Information
Association; Bill Van Gorder, Asthma Advisory Group, Canadian Lung Association |
Chapter 5 |
Alan McFarlane, COPD Working Group, Canadian Lung Association; Roger
Goldstein, Canadian COPD Alliance |
Chapter 6 |
Yang Mao, Centre for Chronic Disease Prevention and Control, Health Canada |
Chapter 7 |
Howard Njoo, Louise Pelletier, and John Spika, Centre for Infectious
Disease Prevention and Control, Health Canada
|
Chapter 8 |
Alan Coates, Hospital for Sick Children, Toronto |
Chapter 9 |
Robin Walker, Children's Hospital of Eastern Ontario, Ottawa |
Data analysis by Louise McRae and Geoffroy Scott of the Disease Intervention
Division, Centre for Chronic Disease Prevention and Control, Health Canada
Writing, editing and layout by Paul Sales, Douglas Consulting
Over 3 million Canadians must cope with serious respiratory diseases - asthma,
chronic obstructive pulmonary disease (COPD), lung cancer, influenza and pneumonia,
bronchiolitis, tuberculosis (TB), cystic fibrosis, and respiratory distress
syndrome (RDS). These diseases affect people of all ages. While in the past
COPD and lung cancer have affected primarily men, the increase in smoking
among women in the past 50 years has resulted in the increased incidence and
prevalence of some of these diseases among women.
Respiratory diseases, including lung cancer, exert a great economic impact
on the Canadian health care system. They account for nearly 12.18 billion
dollars of expenditures per year (1993 dollars). These costs include the direct
or visible costs of health care, such as hospitalization, physician visits
and drugs (over 3.79 billion dollars). They also include the less visible
or indirect expenses associated with disability and mortality, which may be
even more significant (8.39 billion dollars).
This report utilizes currently available data for the surveillance of chronic
respiratory diseases in Canada. While it provides a useful picture, major
gaps exist in the information required to identify problem areas and monitor
the impact of policies, programs and services. A more comprehensive surveillance
system would include data on the incidence, prevalence, risk factors, use
and impact of health services, and health outcomes. This will require an expansion
of data sources. For example, an ongoing population survey would provide information
on quality of life and the use of health services. Improved use and linking
of administrative databases (physician billing, laboratory, drug, hospitalizations)
would add more data on the use of health services and the incidence of respiratory
disease. A reduction in the time lag between data collection and data release
would also increase the usefulness of the existing data.
-
Canada is facing a wave of chronic respiratory diseases. Since many of
these diseases affect adults over the age of 65, the number of people with
respiratory diseases will increase as the population ages. The corresponding
increase in demand for services will pose a significant challenge for the
health care system.
-
Tobacco is the most important preventable risk factor for chronic respiratory
diseases. One in four Canadians smoke cigarettes on a daily basis. In the
short term, smoking cessation among adults will have the greatest impact
on reducing respiratory diseases, such as lung cancer and COPD.
-
The quality of indoor and outdoor air contributes significantly to the
exacerbation of symptoms of respiratory diseases. Air quality issues are
dependent on geography and solutions will vary according to locale.
-
The prevalence of self-reported asthma is higher among women than men
and is increasing for both sexes. The data on activity restriction, emergency
room visits and hospitalization suggest that many individuals with asthma
require help in keeping their disease under control.
-
While in the past COPD was considered as primarily a man's disease, in
1998/99 more women than men reported being diagnosed with COPD. The projected
increase in the number of individuals with COPD will have major implications
for families and for the delivery of comprehensive hospital and community
services.
-
Lung cancer is rapidly becoming a major health issue for women. Both
the incidence and mortality rates among older women are increasing in contrast
to the decreases seen among older men. Societal influences that encouraged
women to smoke 30 to 40 years ago are now being reflected in these trends.
-
In Canada, the proportion of foreign-born TB cases is increasing, due
in large part to the changing immigration patterns to Canada with more people
arriving from TB-endemic areas. The spread of drug-resistant TB strains
throughout the world also represents a threat.
-
Overall, influenza/pneumonia is a major contributor to deaths and hospitalization
among the elderly. It is the leading cause of death from infectious disease
in Canada.
-
Bronchiolitis-associated hospitalizations have increased in the last decade.
The three most likely causes are the increase in the number of children
in child-care centres, the changes in the criteria for hospitalization for
lower respiratory tract infection, and increased survival among premature
babies and those with important medical conditions that place them at high
risk for serious Respiratory Syncytial Virus (RSV) infection. RSV is a primary
cause of bronchiolitis.
-
The face of cystic fibrosis has changed radically in the last 20 years.
While it was once almost exclusively a child's disease, most individuals
with cystic fibrosis are now living into their twenties and thirties. The
health care system needs to become more responsive to the needs of adults
with cystic fibrosis, particularly during the teen-to-adult transition period.
-
The decrease in mortality rates for RDS attests to the success of treatment
in the modern neonatal intensive care unit. Further improvements in neonatal
health will require the prevention of preterm birth, the underlying cause
of RDS.
An effective response to the challenges posed by respiratory diseases and
their risk factors requires the full commitment of governments and the health
care system. The first step is to recognize that respiratory diseases are
major health problems in Canada. The second step involves a collaborative
approach by government, voluntary organizations, health professionals and
institutions toward the prevention and effective management of respiratory
diseases. And finally, a fully effective comprehensive approach would include
other sectors that influence indoor and outdoor air quality.
Figure 1-1 |
Proportion of all hospitalizations due to specific health problems among
men, Canada, 1998. |
Figure 1-2 |
Proportion of all hospitalizations due to specific health problems among
women, Canada, 1998. |
Figure 1-3 |
Proportion of all hospital admissions due to respiratory diseases (among
first five diagnoses) among children aged 0 to 14 years by age group, Canada,
1997. |
Figure 1-4 |
Proportion of all hospital admissions due to respiratory diseases (among
first five diagnoses) among adults aged 15 to 44 years by age group, Canada,
1997. |
Figure 1-5 |
Proportion of all hospital admissions due to respiratory diseases (among
first five diagnoses) among adults aged 45 years and over by age group,
Canada, 1997. |
Figure 1-6 |
Proportion of all deaths due to specific health problems among men, Canada,
1998. |
Figure 1-7 |
Proportion of all deaths due to specific health problems among women,
Canada, 1998. |
Figure 1-8 |
Proportion of all deaths due to respiratory diseases among adults aged
45 years and over by age group, Canada, 1997. |
Figure 1-9 |
Mortality rates for respiratory diseases by neighbourhood income quintile,
urban Canada, 1986, 1991 and 1996 (age-standardized to 1991 Canadian population).
|
Figure 1-10 |
Proportion of direct health care costs (drugs, physicians and hospitals)
due to major health problems, Canada, 1993. |
Figure 1-11 |
Proportion of indirect costs (long- and short-term disability) of major
health problems, Canada, 1993. |
Figure 1-12 |
Proportion of total health care costs (direct, indirect and
research) of major health problems, Canada, 1993. |
Figure 2-1 |
Proportion of adults aged 15+ years who were daily smokers by sex and
province, Canada, 2000. |
Figure 2-2 |
Proportion of adults aged 15+ years who were daily smokers, Canada, 1985-2000.
|
Figure 2-3 |
Proportion of adults who were daily smokers by age group and sex, Canada,
2000. |
Figure 2-4 |
Proportion of adults aged 25+ years who were current or former smokers
by income adequacy* level, Canada, 1998/99. |
Figure 2-5 |
Proportion of youth aged 15-19 years who smoked cigarettes daily, Canada,
1985-2000. |
Figure 2-6 |
Proportion of youth and young adults aged 15-24 years who smoked cigarettes
daily by age group and sex, Canada, 2000.
|
Figure 2-7 |
Proportion of youth aged 15-19 years who reported smoking cigarettes
daily by province, Canada, 2000. |
Figure 2-8 |
Proportion of children under 12 years of age who were exposed to environmental
tobacco smoke in the home every day or almost every day by province, Canada,
2000. |
Figure 2-9 |
Proportion of adults aged 15 to 75 years who reported workplace smoking
restrictions by sex, Canada, 1998/99. |
Figure 2-10 |
Proportion of women who reported smoking during pregnancy by education
level, Canada, 1996/97. |
Figure 3-1 |
Cascading health effects of air pollution. |
Figure 3-2 |
Percentage increased risk of death attributable to change in air pollution
concentrations by city, Canada, 1980-1991. |
Figure 3-3 |
Number of good-fair-poor air quality days, Canada, 1980-1998*. |
Figure 3-4 |
Percentage of maximum acceptable levels, ground-level ozone and gaseous
pollutants*, Canada, 1974-1998. |
Figure 3-5 |
Percentage of maximum acceptable levels* for particulate matter (PM)**,
Canada, 1974-1998. |
Figure 4-1 |
Prevalence of physician-diagnosed asthma among children by age group,
Canada, 1994/95, 1996/97 and 1998/99. |
Figure 4-2 |
Prevalence of physician-diagnosed asthma among adults by age group, Canada,
1994/95, 1996/97 and 1998/99. |
Figure 4-3 |
Asthma hospitalization rates (per 100,000) by age group and sex, Canada,
1998/99. |
Figure 4-4 |
Asthma hospitalization rates (per 100,000) by province/territory, Canada,
1996/97-1998/99 (three-year average) (age/sex-standardized to 1991 Canadian
population). |
Figure 4-5 |
Asthma hospitalization rates (per 100,000) in the younger age groups
by age and sex, Canada excluding territories, 1987/88-1998/99 (standardized
to 1991 Canadian population). |
Figure 4-6 |
Asthma hospital separation rates (per 100,000) among older adults by
age group and sex, Canada excluding territories, 1987/88-1998/99 (standardized
to 1991 Canadian population). |
Figure 4-7 |
Number of hospitalisations by day of year and age group, Canada excluding
Québec, April 1995 - March 2000. |
Figure 4-8 |
Proportion of individuals diagnosed with current asthma who had activity
restriction in past year, Canada, 1997. |
Figure 4-9 |
Asthma deaths by age group and sex, Canada, 1998. |
Figure 4-10 |
Asthma mortality rates (per 100,000) for children and young adults by
age group, both sexes, Canada, 1987-1998 (standardized to the 1991 Canadian
population). |
Figure 4-11 |
Asthma mortality rates (per 100,000) for adults by age group and sex,
Canada, 1987-1998 (standardized to the 1991 Canadian population). |
Figure 4-12 |
Standardized asthma mortality rates by province, Canada, 1996-1998 (three-year
average) (age/sex-standardized to 1991 Canadian population). |
Figure 5-1 |
Prevalence of physician-diagnosed chronic bronchitis and emphysema adults
by age group, Canada, 1994/95, 1996/97 and 1998/99. |
Figure 5-2 |
Chronic obstructive pulmonary disease hospitalization rates (per 100,000)
by age group and sex, Canada, 1998/99. |
Figure 5-3 |
Chronic obstructive pulmonary disease hospitalization rates (per 100,000)
for men by age, Canada excluding territories, 1987/88-1998/99. |
Figure 5-4 |
Chronic obstructive pulmonary disease hospitalization rates (per 100,000)
for women by age, Canada excluding territories, 1987/88-1998/99. |
Figure 5-5 |
Number of individuals hospitalized with chronic obstructive pulmonary
disease actual and projected, Canada excluding territories, 1985-2016. |
Figure 5-6 |
Chronic obstructive pulmonary disease hospitalization rates (per 100,000)
for adults aged 55+ years by province/ territory, Canada, 1996/97-1998/99
(three-year average) (age/sex-standardized to 1991 Canadian population).
|
Figure 5-7 |
Number of hospitalisations for COPD and respiratory tract infections
among men and women aged 50 years of age and over by date, Canada excluding
Quebec, April 1995 to March 2000. |
Figure 5-8 |
Chronic obstructive pulmonary disease mortality rates (per 100,000) by
age and sex, Canada, 1998. |
Figure 5-9 |
Chronic obstructive pulmonary disease mortality rates (per 100,000),
women by age, Canada, 1987-1998.
|
Figure 5-10 |
Chronic obstructive pulmonary disease mortality rates (per 100,000),
men by age, Canada, 1987-1998.
|
Figure 5-11 |
Number of chronic obstructive pulmonary disease deaths, actual and projected,
Canada, 1987-2016.
|
Figure 5-12 |
Chronic obstructive pulmonary disease mortality rates (per 100,000) by
province/territory, Canada, 1996-1998 (three year average) (age/sex standardized
to 1991 Canadian population). |
Figure 6-1 |
Incidence rates (per 100,000) of lung cancer by age group and sex, Canada,
1997.
|
Figure 6-2 |
Incidence rate (per 100,000) of lung cancer by sex, Canada, 1987-2000
(1996+ projected) (age-standardized to 1991 Canadian population). |
Figure 6-3 |
Incidence rate (per 100,000) of lung cancer by age group and sex, Canada,
1987-1996 (age-standardized to 1991 Canadian population). |
Figure 6-4 |
Lung cancer hospitalization rates (per 100,000) by age group and sex,
Canada, 1998/99.
|
Figure 6-5 |
Lung cancer hospitalization rates (per 100,000) by age and sex, Canada
excluding territories, 1987/88-1998/99 (age-standardized to 1991 Canadian
population).
|
Figure 6-6 |
Lung cancer hospitalization rates (per 100,000) among adults aged 45+
years by province, Canada, 1996/97-1998/99 (three-year average) (age/sex-standardized
to 1991 Canadian population). |
Figure 6-7 |
Lung cancer crude mortality rate (per 100,000) by age group and sex,
Canada, 1998. |
Figure 6-8 |
Lung cancer mortality rate (per 100,000) by age group and sex, Canada,1987-1998
(age-standardized to 1991 Canadian population). |
Figure 6-9 |
Lung cancer mortality rate (per 100,000) among adults aged 45+ years
by province, Canada, 1996-1998 (three-year average) (age/sex-standardized
to 1991 Canadian population). |
Figure 7-1 |
Number of cases and incidence rate (per 100,000) of reported new active
and relapsed tuberculosis cases by province/territory, Canada, 1998. |
Figure 7-2 |
Number of cases and incidence rate (per 100,000) of reported new active
and relapsed tuberculosis cases, Canada, 1985-98. |
Figure 7-3 |
Number of cases and incidence rate (per 100,000) of reported new active
and relapsed tuberculosis cases by age group, Canada, 1998. |
Figure 7-4 |
Proportion of reported new active and relapsed tuberculosis cases by
birthplace, Canada, 1998.
|
Figure 7-5 |
Overall pattern of reported TB drug resistance in Canada, 1999 (n = 171). |
Figure 7-6 |
Laboratory Confirmed Influenza in Canada, 1994-1999. |
Figure 7-7 |
Comparison of the 1999/2000 influenza-like illness (ILI) rate to the
average rate in the three-year period from 1996/97 to 1998/99, Canada. |
Figure 7-8 |
Incidence of S. pneumoniae infections by age group, Canada,
1996.
|
Figure 7-9 |
Reduced susceptibility to penicillin for invasive pneumococci in Canada,
1992-2000. |
Figure 7-10 |
Hospitalization rate (per 100,000) for influenza and pneumonia by age
group and sex, Canada, 1998/99. |
Figure 7-11 |
Influenza laboratory isolates and hospitalization rate (per 100,000)
for pneumonia, Canada, 1996-1998.
|
Figure 7-12 |
Hospitalization rate (per 100,000) for influenza and pneumonia among
children aged 0-4 years and adults aged 65+ years by age group and sex,
Canada excluding territories, 1987-1997 (standardized to 1991 Canadian population).
|
Figure 7-13 |
Hospitalization rate (per 100,000) for influenza and pneumonia among
children aged 0-4 years by province/territory (three-year average), Canada,
1996-1998. |
Figure 7-14 |
Hospitalization rate (per 100,000) for influenza and pneumonia among
adults aged 65+ years by province/territory (three-year average), Canada,
1996-1998 (age/sex standardized to 1991 Canadian population). |
Figure 7-15 |
Mortality rate (per 100,000) for influenza and pneumonia among adults
aged 65+ years by age group and sex, Canada, 1998. |
Figure 7-16 |
Mortality rate (per 100,000) for influenza and pneumonia among adults
aged 65+ years by age group and sex, Canada, 1987/98-1998/99 (age-standardized
to 1991 Canadian population). |
Figure 7-17 |
Mortality rate (per 100,000) due to influenza and pneumonia among adults
aged 65+ years by province, Canada, 1998 (age/sex-standardized to 1991 Canadian
population). |
Figure 7-18 |
Number of RSV positive laboratory isolates per month, Canada, 1997/98.
|
Figure 7-19 |
Acute bronchiolitis hospitalization rates (per 100,000) among children
under 5 years of age by age group and sex, Canada, 1998. |
Figure 7-20 |
Hospitalization rates (per 100,000) for acute bronchiolitis among children
4 years of age and under by age group, Canada excluding territories, 1987/88-1998/99. |
Figure 7-21 |
Hospitalization rate (per 100,000) for acute bronchiolitis among infants
to age 12 months by province/territory, Canada, 1996-1998 (three-year average). |
Figure 8-1 |
Number of individuals with cystic fibrosis by age, Canada, 1997.
|
Figure 8-2 |
Number of individuals with cystic fibrosis by age, Canada, 1988-1997.
|
Figure 8-3 |
Number of hospitalizations for cystic fibrosis by age group and sex,
Canada, 1998/99. |
Figure 8-4 |
Hospitalization rate per 100,000 for cystic fibrosis by age group, Canada
excluding territories, 1987/88-1998/99. |
Figure 8-5 |
Hospitalization rate per 100,000 for cystic fibrosis among children and
youth to age 39 years by province, Canada, 1996/97-1998/99 (three-year average)
(age/sex-standardized to 1991 Canadian population). |
Figure 8-6 |
Proportion of deaths caused by cystic fibrosis in age group, Canada excluding
territories, 1988-1998. |
Figure 9-1 |
Rates of preterm birth (percent of livebirths), Canada excluding Ontario,
1990-97. |
Figure 9-2 |
Hospitalization rate (per 100,000) for respiratory distress syndrome
(RDS) for infants to age 12 months by sex, Canada excluding territories,
1987/88-1998/99. |
Figure 9-3 |
Mortality rates (per 100,000) for respiratory distress syndrome (RDS)
for infants to age 12 months, Canada, 1987-1998. |
Table 1-1 |
Number of Canadians affected by respiratory diseases
|
Table 3-1 |
Number of hours the ozone standard was exceeded, by region, Canada, 1979-1994. |
Table 4-1 |
Prevalence of physician-diagnosed asthma by age and sex, Canada, 1998/99. |
Table 4-2 |
Prevalence of physician-diagnosed asthma among Canadians by age group
and sex, Canada, 1994/95, 1996/97 and 1998/99. |
Table 5-1 |
Prevalence of chronic bronchitis or emphysema (COPD) (diagnosed by a
health professional), Canada, 1998/99.
|
Table 5-2 |
Prevalence of physician-diagnosed chronic bronchitis and emphysema among
adults by age group, Canada, 1994/95, 1996/97 and 1998/99. |
Material appearing in this report may be reproduced or
copied without permission. Use of the following acknowledgement to indicate
the source would be appreciated, however:.
© Editorial Board Respiratory Disease in Canada
Health Canada
Ottawa, Canada, 2001
Canadian Cataloguing in Publication Data
ISBN 0-662-30968-5
H39-593/2001E
Aussi disponible en français sous le titre Les
maladies respiratoires au Canada.
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