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Evaluating the usefulness of human health databases in the surveillance of zoonotic, enteric disease in Alberta

Evaluating the usefulness of human health databases in the surveillance of zoonotic, enteric disease in Alberta. Jane Parmley Department of Population Medicine Ontario Veterinary College. Background .

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Evaluating the usefulness of human health databases in the surveillance of zoonotic, enteric disease in Alberta

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  1. Evaluating the usefulness of human health databases in the surveillance of zoonotic, enteric disease in Alberta Jane Parmley Department of Population Medicine Ontario Veterinary College

  2. Background • An apparent high rate of enteric disease was identified in Southern Alberta through routine analysis of the provincial notifiable disease registry

  3. Thesis Questions • Is there a problem? • What is the problem? • Where is the problem?

  4. Thesis objectives • Perform descriptive analyses on four human health databases from Alberta and compare among them • Select a group of controls and compare the geographic and temporal distributions with the cases • Identify risk factors for entry into each of the databases

  5. Thesis material and methods • Databases: • Notifiable Disease Registry • Hospital Discharge Dataset (CIHI) • Physician Visit Dataset (AHCIP) • Emergency Dataset (AHCIP)

  6. Population: • Canada census 1996a • Geographic areas: • Canada census 1996a and Postal code conversion filea • Risk factor data: • Canada census 1996a • Canada census of agriculture 1996a • Water distribution in Albertab • Other aStatistics Canada bFoodborne, Waterborne and Zoonotic Infections Division (CIDPC-Health Canada) and Alberta Ministry of Environment.

  7. Some preliminary findings • The distribution of cases between databases was very different • The distribution of cases and controls within individual databases were very similar

  8. Case distribution by database NDR case CIHI case PV case EMRG case

  9. Rank correlation coefficients between datasets • Significant correlations: • NDR and PV r=0.40 • CIHI and EMRG r=0.39 • PV and EMRG r=0.36 • No correlation between: • NDR and CIHI • NDR and EMRG • CIHI and PV

  10. Case and control distribution CIHI control CIHI case PV control PV case

  11. Rank correlation coefficients between cases and controls • Significant correlations: • CIHI r=0.73 • PV r=0.72 • EMRG r=0.82

  12. So which database should we use for surveillance of zoonotic, enteric pathogens in Alberta?

  13. Why are they different? • Healthcare availability? The nature of disease reporting • Case definition? • Sensitivity of the diagnostic codes • Database objectives? • Surveillance vs administration

  14. Hospital discharge dataset • Administrative • Sensitive to hospital bed availability and changes in service • Reasonable for severe, life-threatening disease

  15. Physician Visit and Emergency Datasets • Administrative • Sensitive to individual physician practices • Diagnostic codes very non-specific • General impression of the health of the community

  16. Notifiable disease registry • Surveillance • All cases are lab confirmed so the pathogen is known (specificity of diagnosis) • Zoonotic • Infectious • Serious under-reporting and bias

  17. Conclusions • Only the Notifiable Disease Registry has enough information on each case to be useful specifically in the surveillance of zoonotic, enteric disease in Alberta • However results obtained from analyses of this data need to be interpreted with caution

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