Canadian Health Measures Survey (CHMS): an introduction and overview Brent Day Health Statistics Division Statistics Canada 1 Statistics Canada Statistique

Canadian Health Measures Survey (CHMS):an introduction and overview

Brent DayHealth Statistics DivisionStatistics Canada

1 Statistics Canada • Statistique Canada

Statistics Canada • Statistique Canada2

CHMS OBJECTIVES

Explore emerging public health issues and new measurement technologies

Establish national baseline data on major health concerns

Determine relationships among risk factors, protection practices and health status

Assess the validity of self- and proxy-reported information

Assemble a nationally representative sample for storage in a biobank

HEALTH SURVEYS PROGRAMCCHS Annual CCHS Rapid

ResponseCCHS Focus Content

CHMS

Content General health surveillance Sample buy-ins

Emerging need - determined by client

Single content in-depth Sample buy-ins

HH information related to physical measures Physical measures in MECLaboratory testsBuy-ins

Sample size 65,000 respondents

11,000 respondents by 2 months collection period

27,000 respondents 5,700 respondents per cycle

Frequency Annual Up to 6 periods by year

Every three years 2 year cycle

Geography Canada, provinces, territories & health regions

Canada & provinces

Canada & provinces Canada only

Age groups 12+ 12+ Varies depending on survey

3 - 79


CHMS: ONE PROJECT, FOUR COMPONENTS

Household component – about 1¼ hours Mobile Examination Centre (MEC) component –

about 2 ¼ to 3 hours Laboratory component – several external

reference labs, one lab in the MEC Biobank component - storage for future health

research of : whole blood, plasma, serum, urine and DNA.


OVERALL RESPONSE RATES: CYCLE 3

All sites (%)Households who provided a list of household members (as a percentage of households within the scope of the survey)

74

Respondents who completed questionnaire (as a percentage of total respondents selected)

88

Respondents who attended mobile clinic (as a percentage of respondents who completed questionnaire)

79

Overall combined response rate (combination of the three response rates above)

52


SURVEY PARAMETERS: CYCLES 3 & 4

National estimates: n = 5,700 each cycle Survey population aged 3 to 79 Direct physical measurements completed in

mobile clinic over 2 years Collection:

• cycle 3 from Jan 2012 to Dec 2013• cycle 4 from Jan 2014 to Dec 2015


Collection sites selected

Households selected

Respondents selected

National sampling frame

(360 eligible collection sites)

SAMPLING STRATEGY: CYCLES 3 & 4

• Collection sites stratified in 5 regions• Covers about 96% of population• 11 age/sex groups from age 3 to 79• Sample size (n = 5,700) to yield

national estimates by sex/age group at 10% prevalence with coefficient of variation of 16.5%

8

COLLECTION SITES: CYCLE 4

St Hyacinthe

Terrace KitimatEdmonton

Brockville

Laval

Montreal

Toronto (2)

Regina

Shelburne

Kelowna

Hamilton

Kitchener-Waterloo

Thunder Bay

Fredericton

Statistics Canada • Statistique Canada

Saguenay


QUESTIONNAIRE CONTENT: CYCLE 3The questionnaire content is to be used only in context with physical measures data and covers the following topics:

Health status

Nutrition and food

Medication use

Health behaviours

Environmental factors

Socio-economic information


THE MOBILE CLINIC


THE MOBILE CLINIC

PHYSICAL MEASURES: CYCLE 3 Anthropometry

• Standing height, sitting height, weight

• Waist and hip circumference

Cardiorespiratory fitness

• Resting blood pressure and heart rate

• Spirometry• Fractional exhaled nitric

oxide (FENO)

Muscular strength• Hand grip strength

Hearing assessment

Skin pigmentation

Physical activity• Accelerometer

Indoor air sampler

Tap water samples (taken from some randomly selected households)



BLOOD AND URINE TESTS: CYCLE 3Blood General: Complete blood count

(CBC), blood chemistry panel Allergies Cardiovascular health: C-

reactive protein (high sensitivity), HDL, LDL, total cholesterol and triglycerides and fatty acids

Diabetes: Fasting, non-fasting and random glucose, fasting insulin and HbA1c

Environmental exposure: Metals (cadmium, lead and mercury (total and methyl)), acrylamide and volatile organic compounds (VOCs)

Infectious diseases: Hepatitis B and C

Nutritional status: Ferritin, red blood cell folate, vitamin B12,

vitamin C and vitamin D Reproductive hormones

Thyroid status

Urine Environmental exposure:

Metals (arsenic (speciated), fluoride and inorganic mercury), benzene

metabolites, bisphenol A, organophosphate insecticides,

polyaromatic hydrocarbons (PAHs), parabens, tobacco and triclosan

Kidney function: Creatinine and microalbumin

Nutritional status: Iodine

MICRODATA FILES (CYCLE 1)

Household questionnaire,

clinic and laboratory measures done on all

respondents

5604 obs.

Ages 6 to 79

MedicationFile

5604 obs.

Ages 6 to 79

Full sample file Medication fileSubsample files

Fasting measures 2,634 6 to 79

Inorganic mercury 1,123 6 to 79

PBDE / PCB 1,696 20 to 79

PFCs 2,880 20 to 79

Activity monitor 4,441 6 to 79

Phthalates 3,237 6 to 49

Nicotine 2,483 12 to 79

Content # obs. Age covered


MICRODATA FILES (CYCLE 2)



respondents

6,395 obs.

Ages 3 to 79

MedicationFile

6,395 obs.

Ages 3 to 79



Indoor air - hhld 3,857 N/A

Indoor air - person 5,191 3 to 79


Environmental blood 1,524 12 to 79

Environmental urine 2,563 3 to 79



MICRODATA FILES (CYCLE 3) - Released



respondents

5,785 obs.

Ages 3 to 79

MedicationFile

5,785 obs.

Ages 3 to 79




RBC fatty acids 1,984 20 to 79

Fluoride - hhld 2,188 12 to 79

Fluoride - person 2,671 12 to 79

VOCs - hhld 2,650 12 to 79



VOCs - person 2,527 12 to 79

PLANS FOR MICRODATA FILES (CYCLE 3) To be released


Release date Topic

July 15, 2015 Environmental lab blood and urine full sample dataAcrylamide subsample (environmental blood)Methyl mercury subsample (environmental blood)NNAL and glucuronides (environmental urine)Environmental urine full sample data

Sept 16, 2015 Indoor air subsample - hhldIndoor air subsample - person

Fall 2015 Medication full sample data (derived variables added)

Fall 2016 Pooled serum data file (50 environmental variables)


CHMS DOCUMENTATION User guide

• Survey content, procedures• Data quality, weighting

Data dictionaries• Information for all variables on the full sample and

subsample files Name, length, data type (character / numeric) Location on the file, applicable values Coverage statements Univariate counts (weighted and unweighted; at RDC only)

Derived variables documentation Sampling documentation


CHMS DOCUMENTATION(CONT’D) Instructions for combining multiple cycles of

CHMS data CHMS Bibliography

• Electronic record of CHMS data releases and analytical products• Includes links to external articles and publications

Content summary document• Content topics in the survey by age for cycles 1 to 8

Information on how to access CHMS documentation on-line


RESEARCH DATA CENTRES (RDCs)

• Access route for most researchers• Allows microdata access in universities across

Canada, under research agreement, in a secure setting

• CHMS microdata and supporting documentation, all Statistics Canada health survey microdata

• Similar files at Health Canada & PHAC

http://www.statcan.gc.ca/rdc-cdr

http://www.statcan.gc.ca/rdc-cdr


STATISTICS CANADA ANALYTICAL PRODUCTS

Health Reports journal articles• Peer reviewed, academic, fairly lengthy• Cycle 3 releases to come:

Prevalence of hearing loss - 20-79 year olds Activity monitor results - 3-5 year olds RBC fatty acids - 3-79 year olds

Health at a Glance articles• Moderate length• Cycle 3 release to come:

Volatile organic compounds - 3-79 year olds

Data tables


STATCAN ANALYTICAL PRODUCTS (CONT’D)

Fact sheets• Plain language, basic descriptive analysis• Cycle 3 already released:

Blood pressure: 1. adults, 2. children and youth Body composition/BMI: 1. adults, 2. children and youth Chronic obstructive pulmonary disease Metabolic syndrome Cholesterol levels Vitamins: 1. C, 2. D Physical activity: 1. adults, 2. children and youth Hearing loss

• Cycle 3 releases to come: 1. Bisphenol A, 2. Tobacco use, 3. Lead, mercury and

cadmium, 4. RBC fatty acids

DATA HIGHLIGHTS FROM CYCLE 3 11% of adults aged 35 to 79 measured airflow obstruction consistent with

chronic obstructive pulmonary disease; however, 90% of these individuals were unaware of their condition

22% of Canadian adults aged 20 and older and 2% of children and youth aged 19 and younger suffer from high blood pressure

65% of Canadians aged 3 to 79 had vitamin D levels that are likely sufficient to fulfill the body’s requirement for optimal bone health while 25% were at risk for inadequate vitamin D and 10% were at risk for having a vitamin D deficiency

21% of Canadian adults aged 18 to 79 suffer from metabolic syndrome

38% of Canadian adults aged 18 to 79 suffer from dyslipidemia; however, half of those individuals were unaware of their condition



Adult total Males Females Children and youth total

Boys Girls0

10

20

30

40

50

60

70

80

EF

EF E F

E

Distribution of adults aged 18 to 79 and children and youth aged 5 to 17, by body mass index (BMI)1 and gender, household population, Canada, 2012 to 2013

Underweight / thinness Normal weight Overweight Obese

percent

E use with caution (data with a coefficient of variation (CV) from 16.6% to 33.3%)

F too unreliable to be published (data with a coefficient of variation (CV) greater than 33.3%; suppressed due to extreme sampling variability)

1. The body mass index (BMI) classification for adults is based on the Canadian guidelines for body weight classification in adults (Health Canada, 2003) and de Onis, et al. (2007) for children and youth.

Source: Canadian Health Measures Survey, 2012 to 2013

25 Statistics Canada • Statistique Canada

Adult total Children and youth total

5 to 11 years 12 to 17 years 18 to 39 years 40 to 59 years 60 to 79 years0

5

10

15

20

25

30

35

40

E

E

E

E

E

F

E

E

E

E

E

E

E

Proportion of adults aged 18 to 79 and children and youth aged 5 to 17 meeting the Canadian Physical Activity Guidelines,1 by age group and sex, Canada, 2012

and 2013

Both sexes Males Females

percent

E use with caution (data with a coefficient of variation from 16.6% to 33.3%)F too unreliable to be published (data with a coefficient of variation (CV) greater than 33.3%; suppressed due to extreme sampling variability

Source: Canadian Health Measures Survey, 2012 and 2013

1 According to the Canadian Society for Exercise Physiology, adults should accumulate at least 150 minutes of moderate to vigorous activity in bouts of at least 10 minutes per week and children and youth aged 5 to 17 are recommended to accumulate at least 60 minutes of moder-ate-to-vigorous physical activity daily

26Source: Canadian Health Measures Survey, 2007-2009. Statistics Canada

Physical Activity Guidelines

19 to 79 years 19 to 39 years 40 to 59 years 60 to 79 years Males FemalesBoth sexes All ages

0

5

10

15

20

25

30

35

40

45

50

E

Chart 1 Hearing loss1 among adults aged 19 to 79, by sex and age group,

Canada, 2012 and 2013

Age group

percent

1. Hearing loss is defined as a speech-frequency pure-tone average consistent with at least mild hearing loss (> 25 decibels in adults aged 19 to 79 or > 20 decibels in children and youth aged 6 to 18) in at least one ear.

Source: Canadian Health Measures Survey, 2012 and 2013.

E use with caution (data with a coefficient of variation from 16.6% to 33.3%)


FUTURE CONTENT CYCLES 5-8

Cycles 5 & 6• Neighbourhood environment• Sleep apnea• Hair (metals)• Saliva (DNA)• Vision• pQCT and mechanography

Cycles 7 & 8• Dual-energy x-ray absorptiometry (DXA)


ADDITIONAL INFORMATION

For more information on the CHMS:

• toll-free number: 1-888-253-1087• e-mail: [email protected]• Web site: www.statcan.gc.ca/chms

mailto:[email protected]

http://www.statcan.gc.ca/chms


QUESTIONS?

Documents

Canadian Health Measures Survey (CHMS): an introduction and overview Brent Day Health Statistics Division Statistics Canada 1 Statistics Canada Statistique