Integrated Longitudinal Health Outcomes Database (ILHO)

Integrated Longitudinal Health Outcomes Database (ILHO)
Summary of changes
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Detailed information for 2023

Status:

Active

Frequency:

Annual

Record number:

5426

The Integrated Longitudinal Health Outcomes (ILHO) database provides detailed and reliable information on the current state of deaths that occur after discharge from hospitals in Canada. The data will be used to develop and validate health care indicators and performance measures, perform survival and outcome analyses on acute inpatient data. This database is the result of a collaboration between Statistics Canada, Canadian Institute of Health Information and Public Health Agency of Canada.

Data release - These data are released internally to Statistics Canada for other surveys or statistical programs to use as part of their data sources.

Description

The Integrated Longitudinal Health Outcomes (ILHO) Database includes administrative health data and death data for all individuals who visited hospitals included in the Discharge Abstract Database since 2000, National Ambulatory Care Reporting System since 2002 and the Ontario Mental Health Reporting System since 2006. The death data stems from the Canadian Vital Statistics Death Database which is an administrative survey which collects demographic and administrative information from all Canadian vital statistics registries since 2000. In addition to the deaths occurring in hospitals which are captured in the hospital datasets, the linked file will provide information on patients who have died following their discharge from an acute care hospital or an emergency room. Statistics Canada does not have Quebec hospitalization data (RAMQ) as part of its data holdings and thus hospitalizations that occurred in the province of Quebec are not included in the linked datasets.

Results from this linked database will be used to develop and validate health care indicators and performance measures as well as perform survival and outcome analyses on acute inpatient data while considering such elements as efficiency, continuum of care, outcomes and disparities in health and longevity. This data is crucial in helping governments devise policies that support access to health care and improve health outcomes for Canadians.

Reference period: For annual administrative data, this is the calendar year or the 12-month financial year beginning on April 1 of the reference year and ending on March 31 of the following year.

Collection period: For Canadian Vital Statistics - Death annual data, approximately 13 months after January 1 of the reference year; for annual CIHI Health Administrative Dataset's, received by Statistics Canada in the third quarter of each year.

Subjects

  • Diseases and health conditions
  • Health
  • Health care services
  • Life expectancy and deaths
  • Mental health and well-being

Data sources and methodology

Target population

The 2023 Integrated Longitudinal Health Outcomes (ILHO) links Discharge Abstract Database, National Ambulatory Care Reporting System and Ontario mental health reporting system to the Canadian Vital Statistics - Death database, through the Derived Record Depository in the Social Data Linkage Environment at Statistics Canada. Any hospitalization or deaths occurring before 2000 are considered out of scope.

Instrument design

This methodology type does not apply to this statistical program.

Sampling

The Integrated Longitudinal Health Outcomes (ILHO) is considered longitudinal after linking the health administrative databases with the Canadian Vital Statistics - Death database (CVSD). The 2023 ILHO members are followed over time using the health administrative data sources until death (CVSD).
These are data sources used:
- Canadian Vital Statistics - Death database (CVSD): January 1st, 2000, to December 31st, 2023
- Discharge Abstract Database (DAD): April 1st, 2000, to March 31st, 2024
- National Ambulatory Care Reporting System (NACRS): April 1st, 2002, to March 31st, 2024
- Ontario Mental Health Reporting System (OMHRS): April 1st, 2006, to March 31st, 2024

Data sources

Data are extracted from administrative files.

The data extracted from the Canadian Vital Statistics — Death database and from the following administrative health data sources, which were obtained under the authority of the Statistics Act, R.S.C. 1985, c. S-19, section 13, were integrated to create ILHO:
- Discharge Abstract Database (DAD)
- National Ambulatory Care Reporting System (NACRS)
- Ontario Mental Health Reporting System (OMHRS).

Administrative health data are an important source of opportunities to improve our knowledge. Statistics Canada's repository of information about its surveys and statistical programs includes information on data processing conducted on the administrative data by the data provider and by Statistics Canada. The Canadian Institute for Health Information (CIHI) maintains metadata about the DAD, the NACRS, and the OMHRS, which include data processing conducted on the administrative data by the data providers (e.g., acute care facilities or their respective health/regional authority or ministry/department of health) and CIHI. Abstracts identifying that a therapeutic abortion was performed based diagnosis codes or intervention codes were deleted by Statistics Canada. Furthermore, some data elements disclosed by CIHI to Statistics Canada are either suppressed or deleted by Statistics Canada.

The Social Data Linkage Environment (SDLE) at Statistics Canada provides a secure environment that maximizes the use of existing survey and administrative data to address important research questions and inform socio-economic policy through record linkage without the need to collect additional data from Canadians. Its Derived Record Depository (DRD) and Key Registry facilitate data integration across multiple domains, such as health, justice, education, and income, using standardized record linkage processes and methods.

At the core of the Integrated Longitudinal Health Outcomes (ILHO) is the paired record identifiers (i.e., linkage keys) between health administrative data sources (Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS), Ontario Mental Health Reporting System (OMHRS)) and the Canadian Vital Statistics - Death database (CVSD). To create this, the health administrative data sources and the CVSD were first separately linked to the DRD. Then, the preliminary linkage keys between the two data sources were extracted from the SDLE's Key Registry. This is followed by data cleaning of the preliminary linkage keys to create the final linkage keys between the health administrative data sources and the CVSD.

Error detection

The Integrated Longitudinal Health Outcomes(ILHO) uses the Canadian Vital Statistics - Death database (CVSD) and administrative data, which have been released and linked to the Derived Record Depository (DRD). Statistics Canada's repository of information about surveys and statistical programs includes information on the methods used to identify missing, invalid or inconsistent entries, or observations that were in error the Canadian Vital Statistics - Death database (CVSD). The Canadian Institute for Health Information (CIHI) reports the methods on error detection for their data holdings such as the Discharge Abstract Database (DAD), the National Ambulatory Care Reporting System (NACRS), and the Ontario Mental Health Reporting System (OMHRS). For example, CIHI's Open-Year Data Quality tests help reporting facilities to create their own data quality audits to identify abstracts with suspected data quality issues and to submit corrections.

The record linkage team works with the understanding that each subject matter program minimizes errors in its data. This enables the team to focus on cleaning of the linkage keys extracted from the SDLE's Key Registry. This data cleaning includes:

1) removing duplicate observations if persons were enumerated more than once in the CVSD,

2) identifying possible false matches between the CVSD and administrative data at the person levels.

After the primary linkage, sex at death or gender and dates (e.g., the admission date and date of death; sex, birth date and date of date between datasets; etc.) across the CVSD and the administrative datasets are compared. For example, persons who were enumerated by one of the administrative datasets, but who died prior to the admission day according to the matched CVSD observations are identified as false matches. However, residual false matches between the CVSD and the DRD remain following this data cleaning, especially among those persons whose death data did not match to the administrative data via the DRD.

Imputation

Not applicable.

Estimation

The Integrated Longitudinal Health Outcomes(ILHO) consists the Canadian Vital Statistics - Death database (CVSD) linked to the Derived Record Depository (DRD) with a linkage rate of 99.4%. The linkage of CVSD to DRD contain linkage weights which were provided by the DRD team. This weights determine with what certainty the linkage was completed. The weights were not reweighed or changed.

Quality evaluation

The Social Data Linkage Environment (SDLE) team routinely assess the quality of the internal and external record linkages they perform. Common data quality measures include duplication rates, linkage rates, linkage error rates, and differences in the distribution of data elements.

To further assess the linkage, the record linkage team uses the final linkage keys between the Canadian Vital Statistics - Death and each administrative health (Discharge Abstract Database, National Ambulatory Care Reporting System,Ontario Mental Health Reporting System) data source to compare common data elements at the record level and population level distributions.

Disclosure control

Statistics Canada is prohibited by law from releasing any information it collects that could identify any person, business, or organization, unless consent has been given by the respondent or as permitted by the Statistics Act. Various confidentiality rules are applied to all data that are released or published to prevent the publication or disclosure of any information deemed confidential. If necessary, data are suppressed to prevent direct or residual disclosure of identifiable data.

Only Statistics Canada employees and deemed employees can be approved to access the confidential microdata.

The linked data should not be used to produce official statistics on hospital-based acute inpatient care, emergency and ambulatory care and/or inpatient mental health care. Official counts and rates are available from the Canadian Institute for Health Information. Any outputs at the institution level will be restricted as per the vetting guidelines. Institution information such as postal code can be used to derive information such as distances to the facilities, but this cannot be used as an outcome of interest.

Furthermore, the linked data should not be used to produce official mortality statistics. Official counts and rates of mortality are available on the Statistics Canada website or can be generated by requesting use of the Canadian Vital Statistics - Death Database, which is accessible through RDC or by requesting a custom tabulation from Statistics Canada (hd-ds@statcan.gc.ca).

Revisions and seasonal adjustment

A yearly revision is completed where the latest years data is added.

Data accuracy

The Integrated Longitudinal Health Outcomes (ILHO) combines the Canadian Vital Statistics - Death database (CVSD) with the administrative data sources (Discharge Abstract Database (DAD), the National Ambulatory Care Reporting System (NACRS), and the Ontario Mental Health Reporting System (OMHRS))through record linkages. Please see Statistics Canada's repository of information about its surveys and statistical programs including information on data accuracy for the Canadian Vital Statistics - Death database (record number 3233).

The Canadian Institute for Health Information maintains metadata about the Discharge Abstract Database, the National Ambulatory Care Reporting System, and the Ontario Mental Health Reporting System, which include information on the data quality to help users decide whether the data fit their needs.

Documentation

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