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To Smoke or not to Smoke? That is the question:Who uses the Canadian acute care system.

GSPP 803 Quantitative MethodsProf Andrea Rounce

Sean McConnachie200 270 499

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Friday, April 10, 2009INDEX:Page

Introduction 1Methodology 1Background Analysis 3Analysis and Findings 4

Univariate Analysis 5Bivariate Analysis 13Multivariate Analysis 21

Recommendations 23Conclusion 24

INTRODUCTIONOver the past decade, there has been a constant and ever progressive

movement to influence the lifestyle choices of Canadians. Canadians are

constantly bombarded with initiative of moral suasion to change theyre

destructive life-styles in order to healthy. These massages are not only

transmitted to us through popular media, but through government

programming as well. In most instances we are provided with information on

the negative impacts of smoking and obesity in our lives and in others. One

of the main pieces of ammunition that is used in the attempts to change

social and individual habits is the personal and social monetary costs that are

associated with these life choices. We are consistently told that smoking and

obesity are a drain on the universal health care system in Canada based on

their level of access and the cost associated with access (SOURCE).

This paper will attempt to examine the extent to which smokers and the

obese use the acute care health care system in Canada. This will be

accomplished by analyzing the extent to which these groups of citizens

access the acute care system relative to those identified as healthy and other

individuals. The findings that will be derived from the analysis that is to

follow will add to previous research on this subject matter to improve the

discourse around the policy issues of smoking and obesity. It is hoped that

the findings of this research will provide new policy insight on this issue and

will assist governments in making better, more informed decisions.

It is hypothesised that there will be a significant relationships between these

cohorts and heath care usage. From this it is further hypothesised that those

identified as smokers and obese use the Canadian health care system to a

similar extent as those that are considered healthy.

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METHODOLOGYIn order to answer the research question previously proposed the Canadian

Community Health Survey 2005 (CCHS 3.1) has been selected as the dataset

for this analysis. Statistics Canada describes the CCHS 3.1 as cross-

sectional survey that collects information related to health status, health careutilization and health determinants for the Canadian population (Canada

2006, pp.1). This survey was conducted on a self-reporting basis, meaning

that status, utilization and determinants are described by the respondent and

are not based on observation or testing.

The survey itself was conducted by employees of Statistics Canada across all

121 health regions within the provinces and territories. The target population

of the CCHS 3.1 is all Canadians that are age 12 and above excluding those

on reserve, institutionalised, members of the armed forces, and living in veryremote regions. From this the CCHS 3.1 covers about 98% of the Canadian

population above the age of 12.

From the CCHS 3.1 variables have been selected that match the initial

research design. For this analysis one dependent, one independent, and four

control variables have been selected. All variables selected have been

recoded in order to fit the parameters of the analysis. The main recode that is

evident within all variables is the removal of all cases under the age of 18

years old as derived from the Body Mass Index classification (BMIC) that hasbeen used by Statistics Canada within the CCHS 3.1 (Canada 2006). Also the

independent variables have been created from the measurements of various

variables provided from the CCHS 3.1.

The dependent variable that has been selected to exemplify individual usage

of the acute care system in Canada is that of number of nights as patient

(heueg01a). Statistics Canada has grouped this variable from other questions

that were asked within the survey. This grouping consisted of the aggregation

of the number of nights an individual stayed at an acute care facility ranging

from 1 to 31. This variable has been recoded to include those that did not

stay over night as a patient in 2005.

In order to construct the population cohorts for the independent variable the

defining of the characteristics of smoking, obese, and healthy individuals is

based on those used by van Baal et al (2008). However this variable will be

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expand in order to increase its descriptive power through the inclusion of an

other category. The variables with the CCHS 3.1 that have been selected to

comprise this derived variable are BMCI (hwtegisw), age (dhhegage), and

type of smoker (smkedsty). Statistics Canada has derived both BMI and type

of smoker. The classification of each cohort is provided in Table 1. A more

thorough explanation of these cohorts will be provided below.

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Table1: Cohort CompositionMeasure CompositionHealthy Never-smoking 18 years ad above with a

body mass index of 18.5 BMI < 25.

Smoker Current daily smoker 18 years ad abovewith and body mass index of 18.5 BMI