Canadian Chronic Disease Surveillance System (CCDSS)

Canadian Chronic Disease Surveillance System Data Tool:
Methods and case definitions

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About the Canadian Chronic Disease Surveillance System (CCDSS)

The CCDSS is a collaborative network of provincial and territorial surveillance systems, supported by the Public Health Agency of Canada (PHAC). The system collects data on all residents who are eligible for provincial or territorial health insurance. It can generate national estimates and trends over time for over 20 chronic diseases and conditions, and other selected health outcomes. To identify people with chronic diseases and conditions, provincial and territorial health insurance registry records are linked using a unique personal identifier to the corresponding physician billing claims, hospital discharge abstract records and prescription drug records.

Key information about the CCDSS methods and case definitions is presented below. More detailed documents are available here: CCDSS summary of methods; CCDSS case definitions.

Use the CCDSS Data Tool

Diseases, conditions and indicators

Table 1: Diseases, conditions and indicators included in the CCDSS
Morbidity and mortality Health events and complications Use of health services
  • incidence
  • prevalence (cumulative and active for select diseases/conditions)
  • all-cause mortality
  • annual prevalence
  • all-cause mortality following a health event
  • annual prevalence
  • all-cause mortality following first health care encounter for select mental illnesses
Cardiovascular diseases
Acute myocardial infarction ✔ ✔
Heart failure ✔
Hypertension, excluding gestational hypertension ✔
Ischemic heart disease ✔
Stroke ✔ ✔
Hospitalized stroke
Chronic respiratory diseases
Asthma ✔
Chronic obstructive pulmonary disease ✔
Diabetes
Diabetes mellitus (types combined), excluding gestational diabetes ✔
Mental illnesses
Mental illness and alcohol/drug induced disorders ✔
Mood and anxiety disorders ✔
Schizophrenia ✔ ✔
Musculoskeletal disorders
Arthritis ✔
Gout and other crystal arthropathies ✔
Juvenile idiopathic arthritis ✔
Osteoarthritis ✔
Rheumatoid arthritis ✔
Osteoporosis ✔ ✔
Osteoporosis-related fractures including forearm, humeral, spine, pelvis, hip and any fracture 		✔
Care gap following an osteoporosis-related fracture
Neurological conditions
Dementia, including Alzheimer disease ✔
Epilepsy ✔
Multiple sclerosis ✔
Parkinsonism, including Parkinson disease ✔
Table 2: CCDSS case definitions and surveillance period reported
Disease, condition and indicator Age Case definition summary First reported year Last reported year
Cardiovascular diseases
Acute myocardial infarction 20+ One or more hospital inpatient admission records 2000–2001 2019–2020
Heart failure 40+ One or more hospital separation records, or two or more physician claims within one year 2000–2001 2019–2020
Hypertension, excluding gestational hypertension 20+ One or more hospital separation records, or two or more physician claims within two years 2000–2001 2019–2020
Ischemic heart disease 20+ One or more hospital separation records or procedure code, or two or more physician claims within one year 2000–2001 2019–2020
Stroke 20+ One or more hospital separation records, or two or more physician claims within one year 2003–2004 2019–2020
Hospitalized stroke (annual) 20+ One or more hospital separation records within one year 2000–2001 2019–2020
Chronic respiratory diseases
Asthma 1+ One or more hospital separation records, or two or more physician claims within two years 2000–2001 2019–2020
Chronic obstructive pulmonary disease 35+ One or more hospital separation records or one or more physician claims 2000–2001 2019–2020
Diabetes
Diabetes mellitus (types combined), excluding gestational diabetes 1+ One or more hospital separation records, or two or more physician claims within two years 2000–2001 2019–2020
Mental illnesses
Use of health services for mental illness and alcohol/drug induced disorders (annual) 1+ One or more hospital separation records or one or more physician claims within one year 2000–2001 2019–2020
Use of health services for mood and anxiety disorders (annual) 1+ One or more hospital separation records or one or more physician claims within one year 2000–2001 2019–2020
Use of health services for schizophrenia (annual) 1+ One or more hospital separation records or one or more physician claims within one year 2000–2001 2019–2020
Schizophrenia 10+ One or more hospital separation records, or two or more physician claims within two years, with at least 30 days between each claim 2002–2003 2019–2020
Musculoskeletal disorders
Use of health services for arthritis (annual) 20+ One or more hospital separation records or one or more physician claims within one year 2000–2001 2019–2020
Gout and other crystal arthropathies 20+ One or more hospital separation records or two or more physician claims (separated by at least 1 day) within five years 2007–2008 2019–2020
Gout and other crystal arthropathies (active) 20+ Once qualified as a gout/crystal arthropathy case: one or more hospital separation records or one or more physician claims within five years 2007–2008 2019–2020
Juvenile idiopathic arthritis ≤15 One or more hospital separation records, or two or more physician claims (> 8 weeks apart) within two years 2000–2001 2019–2020
Osteoarthritis 20+ One or more hospital separation records, or two or more physician claims (separated by at least 1 day) within five years 2007–2008 2019–2020
Rheumatoid arthritis 16+ One or more hospital separation records, or two or more physician claims (> 8 weeks apart) within two years with exclusion criterion 2007–2008 2019–2020
Osteoporosis 40+ One or more hospital separation records or one or more physician claims 2000–2001 2019–2020
Osteoporosis-related fracture – any (annual) 40+ The number of individuals with any fracture (i.e., forearm, hip, humerus, pelvic or spine) 2000–2001 2019–2020
Osteoporosis-related fracture – forearm (annual) 40+ One or more hospital separation records or two or more physician claims within three months (6-month episode) 2000–2001 2019–2020
Osteoporosis-related fracture – hip (annual) 40+ One or more hospital separation records (6-month episode) 2000–2001 2019–2020
Osteoporosis-related fracture – humerus (annual) 40+ One or more hospital separation records or two or more physician claims within three months (6-month episode) 2000–2001 2019–2020
Osteoporosis-related fracture – pelvic (annual) 40+ One or more hospital separation records or two or more physician claims within three months (6-month episode) 2000–2001 2019–2020
Osteoporosis-related fracture – spine (annual) 40+ One or more hospital separation records or one or more physician claims (6-month episode) 2000–2001 2019–2020
Osteoporosis-related fracture care gap – bone mineral density (BMD) test 40+ The % that received a BMD test within 12 months of any osteoporosis-related fracture 2000–2001 2018–2019
Osteoporosis-related fracture care gap – diagnosis 40+ The % that received an osteoporosis diagnosis within 12 months of any osteoporosis-related fracture 2000–2001 2018–2019
Osteoporosis-related fracture care gap – prescribed medication(s) 65+ The % that received an osteoporosis-related medication within 12 months of any osteoporosis-related fracture 2000–2001 2018–2019
Neurological conditions
Dementia, including Alzheimer disease 65+ One or more hospital separation records; or three or more physician claims within two years, with at least 30 days between each claim; or one drug prescription or more 2002–2003 2019–2020
Epilepsy 1+ Age 1-19 years:
Three or more physician claims within two years, with at least 30 days between each claim

Age 20 years and over:
One or more hospital separation records, or three or more physician claims within two years, with at least 30 days between each claim		 2005–2006 2019–2020
Epilepsy (active) 1+ Once qualified as an epilepsy case: one or more hospital separation records or one or more physician claims within five years 2005–2006 2019–2020
Multiple sclerosis 20+ One or more hospital separation records, or five or more physician claims within two years 2003–2004 2019–2020
Parkinsonism, including Parkinson disease 40+ Two or more physician claims within one year, with at least 30 days between the first and the second claim 2004–2005 2019–2020

Data procedures

The following data procedures are applied on the data submitted by the provinces and territories.
  • Age group aggregation for age-specific estimations or rates
    • Data submitted by provinces and territories by five-year age groups are aggregated using the following life course age groups: 1-19, 20-34, 35-49, 50-64, 65-79 and 80+ with a few exceptions. Data by five-year age groups are reported at the national level only.
  • Suppression
    • Estimates, rates, and rate ratios are not reported when the corresponding non-rounded counts are less than 10 or the coefficients of variation are greater than 33.3%.
  • Random rounding
    • To protect data confidentiality and avoid residual disclosure, crude estimates/rates are calculated using randomly rounded counts. All provincial/territorial and Canadian counts 10 or greater are randomly rounded either up or down to a multiple of 5. Random rounding is only used to calculate crude estimates/rates. Age-standardized estimates/rates are based on non-rounded counts.
  • Rate calculation
    • See CCDSS summary of methods.
  • Age standardization
    • Estimates or rates are age-standardized to the 2011 Canada population, using raw counts and five-year age groups, in order to adjust for differences in population age structure.

Provincial and territorial notes

More disease/condition-specific notes, including provincial/territorial specifications, are included in the CCDSS case definitions documentation.
  • Newfoundland and Labrador: Data before 2008–2009 are excluded.
  • Northwest Territories: Data were not available.
  • Nunavut: Data before 2005–2006 are excluded. Data were not available for 2019–2020.
  • Quebec: Data were not available for 1995–1996. Data cells with counts smaller than 5 were suppressed by Quebec and substituted with random numbers (1-4) by PHAC. As a result, age-specific incidence and mortality rates may be randomly over or under estimated.
    The modernization of the billing system for fee-for-service medical services by the Régie de l'assurance maladie du Québec (RAMQ) in 2016 has resulted in a decrease in the entry of diagnostic codes in the fee-for-service medical services file. Data for 2016–2017 and subsequent years should therefore be interpreted with caution, as a slight underestimation is suspected.
  • Saskatchewan: Data cells with counts smaller than 5 were suppressed by Saskatchewan and substituted with random numbers (1-4) by PHAC. As a result, age-specific incidence and mortality rates may be randomly over or under estimated.
  • Yukon: Data before 2010–2011 are excluded.

Suggested citation: Public Health Agency of Canada. Canadian Chronic Disease Surveillance System (CCDSS), Data Tool 2000–2019, 2021 Edition. Ottawa (ON): Public Health Agency of Canada; 2023.

Hashtag: #CCDSS

More information: The Canadian Chronic Disease Surveillance System – An Overview

Contact us: Public Health Agency of Canada, infobase@phac-aspc.gc.ca

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Date modified:
2023-01-30