IV. Hospital Separations

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IV. Hospital Separations

IV.1.

Number of Hospitalizations

A hospital separation is defined as the discharge or death of an inpatient, and is based on counts of events, not patients. Hospital separations are the most comprehensive source of morbidity information. Data for this section is from the Ministry of Health, Saskatchewan year end hospital files for acute care and psychiatric hospital separations for 2001-2002 to 2005-2006. Each hospital discharge is counted only once, under its primary diagnosis (i.e. the diagnosis considered, upon discharge, to have been most responsible for the patient’s hospitalization). Hospital separation rates are not a measure of prevalence or incidence of a disease in the population; but can be used as proxy for the prevalence of a given disease or condition in the population. Hospitalization data captures those illnesses or injuries serious enough to get people admitted to hospital. Administrative policies, accessibility and availability of hospital beds may influence the number and pattern of hospitalization and may not be reflective of true changes in the pattern of disease. This may influence comparison between rural and urban areas of the RQHR and comparison overtime.

Hospitalizations are expressed as number of discharges; a single patient with multiple hospitalizations is counted more than once. There were 40,717 hospitalizations (excluding live births) among rural RQHR residents from 2001 to 2005. This number includes rural residents hospitalized as in-patients in Saskatchewan and out of province hospitals. The number of hospitalizations ranged annually from 7,886 to 8,439. The number of hospitalization among the City of Regina residents for the same period was 96,228 and ranged between 18,965 and 19,768 per year

Over all, more females than males were hospitalized among the rural and City of Regina residents. Rural females accounted for approximately 55% and the City of Regina females for 58% of all hospital separations. However, male hospitalizations were higher than female hospitalizations in all age groups except for those 20-44 and 75 and over (Table IV-1). However, when pregnancy- related admissions are removed, the rural females were only 1.1 more likely to be hospitalized than their urban counterparts (131 separations vs. 123 separations per 1,000). City of Regina men were 1.4 times more likely to be hospitalized (137 vs. 95 hospitalizations per 1,000 population).

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Table IV-1: Number of Hospitalizations by Age and Gender, Rural RQHR and the City of Regina, 2001-2005

Rural Regina

Age group

Males Females Total

Percent

of total Males Females Total

Percent of total < 20 3,119 3,001 6,120 15.0 10,066 9,274 19,340 20.1 20-44 2,177 6,069 8,246 20.3 6,629 19,608 26,237 27.3 45-64 4,467 3,922 8,389 20.6 8,947 8,744 17,691 18.4 65-74 3,383 2,831 6,214 15.3 6,149 5,653 11,802 12.3 75+ 5,229 6,519 11,748 28.9 8,511 12,647 21,158 22.0 Total 18,375 22,342 40,717 100 40,302 55,926 96,228 100

Source: Ministry of Health Saskatchewan year end hospitalization files

Table IV-2 shows that 44 % of all hospitalizations in the rural RQHR occurred in persons aged 65 years and older compared to 34% in the City of Regina. The proportion of

hospitalizations at age less than 45 years was lower in the rural RQHR (35% vs. 47%).

Table IV-2: Number and Percent of Hospital Separations, by Age Group, Rural RQHR and City of Regina, 2001-2005

Rural Regina Age Group Separations % Separations % < 20 6,120 15.0 19,340 20.1 20-44 8,246 20.3 26,237 27.3 45-64 8,389 20.6 17,691 18.4 65-74 6,214 15.3 11,802 12.3 75+ 11,748 28.9 21,158 22.0 Total 40,717 100 96,228 100

The overall hospitalization rate for the rural RQHR and the City of Regina remained fairly stable for the period 2001 to 2005. The rural rate was consistently higher than the City of Regina rate. This variation may be due to the differences in the age structure of the population (Table IV-3).

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Table IV-3: Number and Rate of Hospital Separations, Rural RQHR and City of Regina, 2001-2005 Rural Regina Year Number of separations

Rate per 1,000 Number of

separations Rate per 1,000 2001 8,061 120.4 19,768 101.4 2002 7,886 117.3 19,065 97.6 2003 8,399 126.7 19,237 100.0 2004 7,937 118.0 18,965 96.8 2005 8,439 124.3 19,193 97.2

Hospital separation rates for females were higher than for males for both the rural and Regina city residents throughout the period 2001-2005 (Figure IV-1).

Figure IV-1: Hospitalization Rates, by Gender, Rural RQHR and City of Regina, 2001-2005 0 20 40 60 80 100 120 140 160 Year Ag e St a n da rd iz ed R a te pe r 1 ,0 00 Rural Male 106 6 103 0 109 3 106 6 107 1 Rural Female 135 5 133 3 145 1 130 8 143 1 Regina Male 93 5 89 5 88 3 86 1 84 6 Regina Female 111 2 107 4 112 5 108 6 110 9 2001 2002 2003 2004 2005

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IV.2.

Age Specific Hospitalization Rates

The age specific rate of hospitalizations in the rural RQHR and the City of Regina are shown in Figure IV-2. The rates for rural residents were higher than the City of Regina in all age groups except for 0-4 and 5-9 years. For both the rural RQHR and the urban setting, the rates increased with age for those older than 40-44 years.

Figure IV-2 Age Specific Hospitalization Rate, Rural RQHR and City of Regina, 2001-2005 0 100 200 300 400 500 600 0-4 5-9 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+ Age Group Rat e per 1,000 Rural Regina

Both rural and City of Regina females aged 15 to 44 had hospitalization rates much higher than males of the same age, primarily because of childbirth-related

hospitalizations. Males aged 55 and over have higher rates of hospitalization than females in both the rural RQHR and the City of Regina (Figure IV-3 and Figure IV-4).

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Figure IV-3: Age Specific Hospitalization Rates, by Gender, Rural RQHR, 2001-2005 0 100 200 300 400 500 600 0-4 5-9 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+ Age Group Ra te p e r 1 ,00 0 Male Female

Figure IV-4: Age Specific Hospitalization Rates, by Gender, City of Regina, 2001-2005 0 100 200 300 400 500 0-4 5-9 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+ Age Group R at e per 1, 000 Male Female

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IV.3.

Hospitalizations by Primary Diagnosis

The causes of hospitalization for the rural RQHR and the City of Regina residents are given in Table IV-4.

Table IV-4: Causes of Hospitalization, Rural RQHR and City of Regina, 2001-2005

Separations Separations per

1,000 population ICD 9

code Primary Diagnosis

Rural Regina Rural Regina 630-676 Pregnancy, childbirth and the

puerperium 3,302 12,490 14.5 14.6

390-459 Diseases of the circulatory

system 5,601 12,023 13.9 11.1

520-579 Diseases of the digestive system 4,691 10,884 13.9 11.1

460-519 Diseases of the respiratory

system 4,529 9,779 12.7 10.0

800-999

Injury and poisoning and certain other consequences of external causes

3,545 9,052 10.8 9.2

780-799

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

3,226 6,964 9.3 7.0

V01-V86 Classification of factors

influencing health status 2,912 3,881 8.5 3.9

580-629 Diseases of the genitourinary

system 2,185 5,440 6.6 5.5

710-739 Diseases of the musculoskeletal

system and connective tissue 2,288 5,467 6.6 5.4

140-239 Neoplasms 1,948 5,376 5.3 5.2

240-279 Endocrine, nutritional and

metabolic diseases 1,348 2,486 3.7 2.4

320-389 Diseases of the nervous system 1,179 2,147 3.4 2.2

760-779 Certain conditions originating in

the perinatal period 992 3,874 3.2 4.3

290-319 Mental and behavioural disorders 977 1,438 3.0 1.5

001-139 Infectious and parasitic diseases 732 2,319 2.3 2.5

680-709 Diseases of the skin and

subcutaneous tissue 584 863 1.7 0.9

280-289

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

443 935 1.2 0.9

Total (excluding live births) 40,717 96,228 125.2 101.1

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For 2001-2005, the leading causes of hospital separations for both the rural RQHR and the City of Regina were diseases of the circulatory, respiratory and digestive systems, injuries and poisonings and complications of childbirth, pregnancy and puerperium (Table IV-5). The proportion of separations for each disease category in the rural and urban areas were similar, with the exception of complications of childbirth, pregnancy and puerperium, where the percentage for the rural area was lower than that of the City of Regina (13 % vs. 8%)

Table IV-5: Hospital Separations by ICD 9 Diagnostic Groups, Rural RQHR and City of Regina, 2001-2005

Proportion of total hospital separations Diagnostic Group - ICD 9 Chapters

Rural (%)

Regina (%)

Diseases of the circulatory system 13.8 12.5

Diseases of the digestive system 11.5 11.3

Diseases of the respiratory system 11.1 10.2

Injury, poisoning and certain other consequences of external causes 8.7 9.4

Symptoms, signs and ill defined conditions 7.9 7.2

Classification of factors influencing health status and contact with health services 7.2 4.0

Neoplasms 4.8 5.6

Endocrine, nutritional and metabolic diseases 3.3 2.6

Diseases of the nervous system 2.9 2.2

Certain conditions originating in the perinatal period 2.4 4.0

Mental and behavioural disorders 2.4 1.5

Infectious and parasitic diseases 1.8 2.4

Diseases of the blood and blood-forming organs 1.1 1.0

The top leading causes of hospital separations for males are the same for both the rural RQHR and the City of Regina. The causes are diseases of the circulatory, respiratory and digestive systems and injuries and poisonings. The proportions of the separations listed in each category are similar.

The top leading causes of hospital separations for woman in the rural RQHR and the City of Regina are complications of pregnancy, childbirth and puerperium followed by

diseases of the digestive, circulatory and respiratory systems. The rural and urban proportions are similar for each category except for hospital separations due to

pregnancy, childbirth and puerperium. The percentage for the rural RQHR is 15 and 22 for the City of Regina (Table IV-6).

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Table IV-6: Hospital Separations by ICD 9 Diagnostic Group, by Gender, Rural RQHR and City of Regina, 2001-2005

Proportion of total hospital separations

Rural Regina

Diagnostic Group - ICD 9 Chapters

Males (%)

Females

(%) Males (%)

Females (%)

Certain infectious and parasitic diseases 2.0 1.7 2.9 2.1

Neoplasms 5.0 4.6 5.5 5.7

Endocrine, nutritional and metabolic diseases 3.6 3.1 2.8 2.5

Diseases of the blood and blood-forming organs 1.1 1.1 1.0 1.0

Mental and behavioural disorders 2.4 2.4 1.8 1.3

Diseases of the nervous system 3.8 2.1 2.6 2.0

Diseases of the circulatory system 16.8 11.3 16.3 9.8

Diseases of the respiratory system 13.0 9.6 12.4 8.5

Diseases of the digestive system 11.7 11.4 12.4 10.5

Diseases of the genitourinary system 4.9 5.8 5.0 6.1

Complications of Pregnancy, childbirth and the

puerperium 0.0 14.8 0.0 22.3

Diseases of the skin and subcutaneous tissue 1.7 1.2 1.1 0.7

Diseases of the musculoskeletal system and

connective tissue 5.7 5.5 6.2 5.3

Congenital anomalies 0.7 0.4 1.2 0.6

Certain conditions originating in the perinatal

period 2.9 2.1 5.3 3.1

Symptoms, signs and ill defined conditions 8.1 7.8 7.7 6.9

Injury, poisoning and certain other consequences

of external causes 10.0 7.6 11.5 7.9

Classification of factors influencing health status

and contact with health services 6.8 7.4 4.4 3.8

From 2001 to 2005, the trends in the leading causes of hospital separations remained fairly stable for both the rural RQHR and the City of Regina. Age standardized trends for select major disease groups (ICD chapters) are shown in Figure IV-5 and Figure IV-6.

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Figure IV-5: Trends for Leading Causes of Hospital Separation, Rural RQHR, 2001-2005 0 5 10 15 20 2001 2002 2003 2004 2005 Year R a te pe r 1 ,0 0 0 pop ul a ti on

Circulatory Digestive Respiratory Injuries Neoplasm

Figure IV-6: Trends for Leading Causes of Hospital Separation, City of Regina, 2001-2005 0 4 8 12 16 2001 2002 2003 2004 2005 Year R a te pe r 1 ,0 0 0 pop ul a ti on

Circulatory Digestive Respiratory Injuries Neoplasm

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IV.4. Leading Causes of Hospital Separations by Age Group

The relative contribution of cause of hospitalization varies with age. From 2001 to 2005, there were 3,169 hospital separations for children aged 0-4 years in rural area and 12,182 separations in the City of Regina accounting for 8% and 13% respectively of all hospital separations. The five leading causes are the same for both the rural and urban areas and accounted for 75% of all separations in this age group (Table IV-7).

Table IV-7: Leading Causes of Hospital Separations, 0-4 years old, Rural RQHR and City of Regina, 2001-2005

Proportion of total 0-4 years old hospital separations

Category

Rural Regina

Certain conditions originating in the perinatal

period 31.3% 31.8%

Diseases of the Respiratory System 28.2% 26.8%

Congenital anomalies 6.1% 5.3%

Certain infections and parasitic diseases 5.2% 7.0%

Injury, poisoning and certain other

consequences of external causes 4.0% 3.8%

For those aged 5-19, there were 2,951 separations rurally and 7,158 in the urban setting, accounting for 7% of all hospital separations in both areas. The leading causes for both are the same, and the percentages for each category are similar, except for conditions of pregnancy and childbirth, where the urban proportion in slightly higher (Table IV-8).

Category

Rural Regina

Injury, poisoning and certain other consequences of external causes

20.0% 19.3%

Complications of Pregnancy and Child birth 12.5% 15.8%

Diseases of the Digestive System 12.0% 12.0%

Certain infections and parasitic diseases 4.6% 4.7%

From 2001 to 2005, a total of 8,246 hospitalizations occurred in the 20-44 year age group for the rural RQHR and 26,237 hospitalizations for the City of Regina. The five leading causes accounted for 66% and 73% respectively of all separations in this age group. As

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Category

Rural Regina

Complications of Pregnancy and Child birth 35.5% 43.3%

Diseases of the genitourinary system 5.8% 5.8%

There were a total of 8,389 hospitalizations in the 45-64 year age group in the rural RQHR and 17,691 in the City of Regina. The five leading causes accounted for 53% of all separations in the Rural RQHR and 61% of all separations in the City of Regina in this age group. The five leading causes of hospital separations are the same for both the rural and urban areas. The urban proportions are slightly higher for each category except diseases of the digestive system (Table IV-10).

Category

Rural Regina

Diseases of the Circulatory System 13.5% 16.5%

Diseases of the Musculoskeletal system 8.2% 9.0%

Neoplasms 7.8% 11.1%

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There were a total of 17,962 hospital separations for rural residents 65 years and older and 32,960 separations for urban residents in that age group. These accounted for 44% of all separations in the rural RQHR and 34% of all separations in the City of Regina. The five leading causes for both the rural and urban areas are the same and the proportions for each category similar (Table IV-11).

Table IV-11: Leading Causes of Hospital Separations, Aged 65 and older, Rural and City of Regina, 2001-2005

Proportion of total 65 years and older hospital separations

Category

Rural Regina

Diseases of the Circulatory System 23.4% 25.1%

Injury, poisoning and certain other consequences of external causes

7.4% 9.0%

Diseases of the Musculoskeletal system 6.3% 6.8%

Neoplasms 5.9% 8.0%

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IV.5.

Chronic Disease Hospitalizations

IV.5.1. Ischemic Heart Disease

From 2001 to 2005, an average of 336 rural RQHR residents was hospitalized per year for ischemic heart disease (ICD 9 codes 411-414). The age standardized hospitalization rate was 430 per 100,000 population. There was an average of 815 hospital separations for ischemic heart disease among the City of Regina residents for a hospitalization rate of 380 per 100,000. For both rural and urban residents, the male ischemic heart disease hospitalization rate was higher than the female rate. Rural males had the highest rate of ischemic heart disease hospitalization. The lowest ischemic heart disease hospitalization rates were among the City of Regina females (Figure IV-7).

Figure IV-7: Age Standardized Hospitalization Rates, Ischemic Heart Disease, by Gender, Rural RQHR and City of Regina, 2001-2005

436 9 615 0 271 5 388 1 560 2 246 9 0 100 200 300 400 500 600 700

Total Male Female

Ra te p er 10 0,00 0 pop u latio n Rural Regina

Hospitalizations due to ischemic heart disease remained consistently higher in the rural RQHR residents except for 2002. While the hospitalization rates for the rural RQHR have fluctuated, the City of Regina rates declined steadily from 2001 to 2005 (Figure IV-8).

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Figure IV-8: Age Standardized Hospitalization Rates, Ischemic Heart Disease, Rural RQHR and City of Regina, 2001-2005

0 100 200 300 400 500 600 Year Rat e per 100,000 Rural 502 3 392.7 428.7 466.6 396.7 Regina 458 2 440.3 360.3 354.7 332 2 2001 2002 2003 2004 2005

The ischemic disease hospitalization rate increased with age for both the rural and urban residents. Very few hospitalizations occurred in rural and urban residents under the age of 45.

IV.5.2. Cerebrovascular Diseases

From 2001 to 2005, an average of 152 hospitalizations due to cerebrovascular diseases (ICD 9 code 430-438) occurred among rural RQHR residents for an age standardized hospitalization rate of 180 per 100,000. Age standardized hospitalization rates from cerebrovascular diseases for 2001 to 2005 combined were higher among males compared to females in both the rural and urban RQHR (Figure IV-9) These rates were higher for every year among rural residents except 2005 (Figure IV-10).

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Figure IV-9: Age Standardized Hospitalization Rates, Cerebrovascular Disease, by Gender Rural RQHR and City of Regina, 2001-2005

195 7 218 2 174 8 165 6 189 1 147 9 0 50 100 150 200 250

Total Male Female

R a te p er 100, 00 0 Rural Regina

Figure IV-10: Age Standardized Hospitalization Rates, Cerebrovascular Disease, Rural RQHR and City of Regina, 2001-2005

0 50 100 150 200 250 Year R a te p er 100 ,0 00 Rural 215 1 188 5 201 9 203 9 168 7 Regina 149 4 179 7 175 3 164 2 189 3 2001 2002 2003 2004 2005

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IV.5.3. Chronic Obstructive Pulmonary Disease

From 2001-2005, an average of approximately 300 hospital separations per year occurred in rural and 750 among Regina city residents for chronic obstructive pulmonary disease (COPD). The age standardized hospitalization rates for COPD were 451 per 100,000 in rural males, higher than the City of Regina males (407 per 100,000). The rates in rural females were similar to urban females (Figure IV-11). The age standardized

hospitalization rates for COPD was higher among rural residents as compared to the City of Regina (Figure IV-12).

Figure IV-11: Age Standardized Hospitalization Rates, Chronic Obstructive Pulmonary Disease, by Gender Rural RQHR and City of Regina, 2001-2005

393.6 450 9 351.9 374 6 407.0 351.1 0 100 200 300 400 500

Total Male Female

R

a

te per 100,000

Rural Regina

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Figure IV-12: Age Standardized Hospitalization Rates, Chronic Obstructive Pulmonary Disease, Rural RQHR and City of Regina, 2001-2005

0 100 200 300 400 500 600 Year Rat e per 100,000 Rural 364.4 349.8 414.9 373.9 464 0 Regina 333 6 357.6 381.5 361.4 437 6 2001 2002 2003 2004 2005

IV.5.4. Diabetes

Diabetes is associated with poor health status, limitation of daily activities and significant comorbidities. From 2001 to 2005, there was an average of 160 hospitalizations per year for diabetes among the rural residents. For the same period an average of 240

hospitalizations per year were attributed to diabetes among the City of Regina residents. The age standardized hospitalization rates was 224 per 100,000 for rural RQHR

compared to 119 for the City of Regina. The male rates were higher than the female rates for both the rural and urban areas (Figure IV-13). The age standardized rate for rural residents was considerably higher than the City of Regina residents for this period (Figure IV-14).

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Figure IV-13: Age Standardized Hospitalization Rates, Diabetes, by Gender Rural RQHR and City of Regina, 2001-2005

223.8 254 0 193.8 119.1 146.2 99 6 0 50 100 150 200 250 300

Total Male Female

R at e per 100, 000 Rural Regina

Figure IV-14: Age Standardized Hospitalization Rates, Diabetes, Rural RQHR and City of Regina, 2001-2005 50 100 150 200 250 300 R a te p er 100 ,0 00

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IV.5.5. Lung Cancer

From 2001-2005, there was an average of 33 hospitalizations for lung cancer among rural residents per year. Hospitalization for cancer was very uncommon prior to age 45 among rural and the City of Regina residents. The number of hospitalizations for lung cancer among rural residents varied widely from 17 to 45 per year (Figure IV-15). The high degree of variability is due to the small number of hospital separations in the rural area.

Figure IV-15: Age Standardized Hospitalization Rates, Lung Cancer, Rural RQHR and City of Regina, 2001-2005

0 20 40 60 80 Year Ra te p er 10 0, 00 0 Rural 44 9 56 9 55 9 36 5 22 6 Regina 43 2 31 0 37 5 44 5 41 5 2001 2002 2003 2004 2005