Respiratory Disease in Canada

Canadian Institute for Health Information
Canadian Lung Association
Health Canada
Statistics Canada

Table of Contents

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

 

Foreword

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

 

Acknowledgements

Editorial Board

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

Production Team

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

 

Summary

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.

Key Points

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

A Final Word

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.

---

 

List of Figures

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.

 

List of Tables

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.