Open Access Highly Accessed Research article

Surveillance of ischemic heart disease should include physician billing claims: population-based evidence from administrative health data across seven Canadian provinces

Cynthia Robitaille1, Christina Bancej1, Sulan Dai1*, Karen Tu2, Drona Rasali3, Claudia Blais45, Céline Plante4, Mark Smith6, Lawrence W Svenson789, Kim Reimer10, Jill Casey11, Rolf Puchtinger12, Helen Johansen13, Yana Gurevich14, Chris Waters1, Lisa M Lix15 and Hude Quan7

Author Affiliations

1 Public Health Agency of Canada, 785 Carling Avenue, Mail Stop: 6806A, K1A 0K9, Ottawa, ON, Canada

2 Institute for Clinical Evaluative Sciences, Department of Family and Community Medicine-University of Toronto and University Health Network-Toronto Western Hospital Family Health Team, Toronto, ON, Canada

3 British Columbia Provincial Health Services Authority, Vancouver, BC, Canada

4 Institut national de santé publique du Québec, Québec City, QC, Canada

5 Faculté de pharmacie, Université Laval, Québec City, QC, Canada

6 Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada

7 Faculty of Medicine, University of Calgary, Calgary, AB, Canada

8 Alberta Health, Edmonton, AB, Canada

9 School of Public Health, University of Alberta, Edmonton, AB, Canada

10 British Columbia Ministry of Health, Victoria, BC, Canada

11 Nova Scotia Department of Health and Wellness, Halifax, NS, Canada

12 Saskatchewan Ministry of Health, Regina, SK, Canada

13 Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada

14 Canadian Institute for Health Information, Toronto, ON, Canada

15 University of Manitoba, Winnipeg, MB, Canada

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BMC Cardiovascular Disorders 2013, 13:88  doi:10.1186/1471-2261-13-88

Published: 20 October 2013



Canadian provinces and territories routinely collect health information for administrative purposes. This study used Canadian medical and hospital administrative data for population-based surveillance of diagnosed ischemic heart disease (IHD).


Hospital discharge abstracts and physician billing claims data from seven provinces were analyzed to estimate prevalence and incidence of IHD using three validated algorithms: a) one hospital discharge abstract with an IHD diagnosis or procedure code (1H); b) 1H or at least three physician claims within a one-year period (1H3P) and c) 1H or at least two physician claims within a one-year period (1H2P). Crude and age-standardized prevalence and incidence rates were calculated for Canadian adults aged 20 +.


IHD prevalence and incidence varied by province, were consistently higher among males than females, and increased with age. Prevalence and incidence were lower using the 1H method compared to using the 1H2P or 1H3P methods in all provinces studied for all age groups. For instance, in 2006/07, crude prevalence by province ranged from 3.4%-5.5% (1H), from 4.9%-7.7% (1H3P) and from 6.0%-9.2% (1H2P). Similarly, crude incidence by province ranged from 3.7-5.9 per 1,000 (1H), from 5.0-6.9 per 1,000 (1H3P) and from 6.1-7.9 per 1,000 (1H2P).


Study findings show that incidence and prevalence of diagnosed IHD will be underestimated by as much as 50% using inpatient data alone. The addition of physician claims data are needed to better assess the burden of IHD in Canada.

Ischemic heart disease; Incidence; Prevalence; Hospital administrative data; Canada