Report from the National Diabetes Surveillance System: Diabetes in Canada, 2009

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NDSS Future Plans

The NDSS provides a valuable source of information about diabetes in Canada. Future work will include:

• Continuing work with First Nations, Métis, and Inuit organizations to produce additional NDSS data for analysis, interpretation, and up-to-date reporting, to gain a better understanding of diabetes among these populations;
• Expanding the breadth of data reporting on diabetes and other related conditions among adults, children, and adolescents; a “Hypertension in Canada” report is planned for the Spring of 2010;
• Exploring the use of ICD-10-CA diagnosis coding in hospitals and pharmaceutical data to differentiate between type 1 and 2 diabetes; and,
• Continuing to foster a standard approach for high data quality.

Glossary

Diagnosed Diabetes: This surveillance system summarized data about residents of Canada who have used the Canadian health care system. If there is sufficient evidence of use due to diabetes, it was assumed that a person had diagnosed diabetes. The minimum requirement was at least 1 hospitalization or 2 physician claims, with a diabetes specific code(s), over a 2-year period.

Diagnosed Hypertension: Diagnosed hypertension was also tracked. The minimum requirement was at least 1 hospitalization or 2 physician claims, with a hypertension specific code(s), over a 2-year period.

Prevalence: The proportion of individuals that are affected by diagnosed diabetes at a given point in time.

Age-Standardized: Rates are adjusted for changes in the age structure of the population over time or for differences in age structure across provinces or territories. Refer to the NDSS methods report for more information.

Incidence: The number of individuals newly diagnosed with diabetes during the year.

Incidence rate: The rate of individuals newly diagnosed with diabetes among those at risk during the year.

Estimated Annual Percent Change: The annual percent change is based on the loglinear regression analysis (e^0.07003 -1) X 100 = 7.2

False-negatives: Individuals who have not met the NDSS case criteria, but have diabetes. The potential proportion of false negatives was indicated by the NDSS validation studies.

False-positives: Individuals who have met the NDSS case criteria, but do not have diabetes. The potential proportion of false positives was indicated by the NDSS validation studies.

Canadian Coding Standards:Also beginning with the 2006-2007 data, the Canadian Coding Standards for ICD-10-CA and CCI, 2009⁷ mandated that all provinces and territories include any information about patients with diabetes in their hospitalization data. This new practice could enable the NDSS to identify more people with diabetes, and find them earlier, from the hospitalization data. This situation will be monitored to determine the effect and magnitude on the data collected by the surveillance system.

Status Verification File (SVF): The Indian Register is a list of Registered or Status Indians (as defined by the Indian Act) kept by Indian and Northern Affairs Canada. Information about the demographic characteristics of the Indian population is updated regularly by band officials and is published on a yearly basis. The Status Indian population has certain rights that may include on-reserve housing benefits, education, and exemption from federal, provincial, and territorial taxes in specific situations. The SVF contains information on the entire Status Indian population in Canada and contains a subset of the variables available on the Indian Register. The SVF is managed by the First Nations and Inuit Health Branch, Health Canada.

Refer to the NDSS Methods Report for more information.

Acknowledgements

The NDSS is guided by the Public Health Network's Task Group on Surveillance of Chronic Disease and Injury with the following members:

• Alberta Health and Wellness
• British Columbia Ministry of Healthy Living and Sport
• Canadian Institute of Health Information
• Canadian Institutes of Health Research/Institute of Nutrition, Metabolism and Diabetes
• Government of Nunavut
• Government of Yukon
• Health Canada, First Nations and Inuit Health Branch
• Institut national de santé publique du Québec
• Manitoba Health
• New Brunswick Department of Health
• Newfoundland and Labrador Centre for Health Information
• Northwest Territories Department of Health and Social Services
• Nova Scotia Department of Health
• Ontario Ministry of Health and Long/Term Care and Ministry of Health Promotion
• Prince Edward Island Department of Health
• Public Health Agency of Canada
• Saskatchewan Ministry of Health
• Statistics Canada

Expert advice was provided by the members of the NDSS Scientific Working Group:

• Gillian Booth, St. Michael's Hospital, University of Toronto
• Kayla Collins, Newfoundland and Labrador Centre for Health Information
• Hasan Hutchinson/Paul Belanger, Institute of Nutrition Metabolism and Diabetes, Canadian Institutes of Health Research
• Jeffrey Johnson (Co-Chair), School of Public Health, University of Alberta
• Isabelle Larocque, Institut national de santé publique du Québec
• Rolf Puchtinger, Chronic Disease Branch, Manitoba Health and Healthy Living
• Indra Pulcins, Canadian Institute for Health Information
• Kim Reimer (Co-Chair), Prevention and Health Promotion, British Columbia Ministry of Healthy Living and Sport
• Mark Smith, Manitoba Centre for Health Policy
• Larry Svenson, Public Health Surveillance and Environmental Health, Alberta Health and Wellness
• Ellen Toth, Department of Medicine, University of Alberta
• Linda Van Til, Research Directorate, Veteran Affairs Canada
• Karen Tu, Institute for Clinical Evaluative Sciences

Data quality and verification expertise are provided by the members of the NDSS Technical Working Group:

• Fred Ackah, Alberta Health and Wellness
• Jill Casey, Nova Scotia Department of Health
• Connie Cheverie, Prince Edward Island Department of Health
• Wendy Fonseca-Holt, Chronic Disease Branch, Manitoba Health and Healthy Living
• Janice Hawkey, Saskatchewan Health
• Alexander Kopp, Institute of Clinical and Evaluative Services
• Pat McCrea, British Columbia Ministry of Healthy Living and Sport
• Robin Read, Diabetes Care Program of Nova Scotia
• Louis Rochette, Institut national de santé publique du Québec
• Anthony Leamon, Population Health, Department of Health and Social Services, Government of the Northwest Territories
• Khokan Sikdar, Newfoundland and Labrador Centre for Health Information
• Mike Tribes, Government of Yukon, Health and Social Services
• Bao Gang Fei, Department of Health, New Brunswick
• Paul Tchouaffi, Department of Health and Social Services, Health Information and Research, Iqualuit, Nunavut

The Diabetes Surveillance Advisory Committee, chaired by the Canadian Diabetes Association, advises PHAC on diabetes surveillance in Canada.

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