Understanding future needs of Canadian veterans.

BACKGROUND: Planning for the future needs of Canadian veterans requires comprehensive and detailed data on the size of the Canadian veteran population and their health. This article describes current veteran population estimates and examines the health of two eras of veterans compared with the health of Canadians in general. DATA AND METHODS: This study describes the size and age structure of the Canadian veteran population forecasted by Veterans Affairs Canada (VAC). Veteran health was examined for two eras of Regular Force veterans. The health of earlier-era veterans (released between 1954 and 2003) was examined using the 2003 Canadian Community Health Survey. The health of recent-era veterans (released between 1998 and 2012) was examined using the 2013 Life After Service Survey. Health indicators for veterans were compared with the Canadian general population using age- and sex-adjusted rates and confidence intervals. RESULTS: The VAC forecast points to a stable population of about 600,000 veterans for the next decade, but a growing proportion will be older than 70 years old. Regular Force veterans of both eras had a higher prevalence than the Canadian general population of activity limitations and back problems, a lower prevalence of low income, and a similar prevalence of life stress and heavy drinking. Recent-era veterans had a higher prevalence than the Canadian general population of many more indicators-in particular, arthritis, self-rated mental health, depression and anxiety. DISCUSSION: Veterans differed from the Canadian general population in many areas of well-being, and recent-era veterans differed in more areas than earlier-era veterans. These results highlight the need for forecasting and planning, and for policy that is sensitive to these differences and incorporates health status changes as veterans age. Multiple data sources will be required to describe the future health needs of the entire Canadian veteran population.

The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance.

Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities.