Chronic conditions in childhood: Technical notes

Technical notes for the analysis of the 2019 and 2023 Canadian Health Survey on Children and Youth.

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Data source

Data used in this report are from the 2019 and 2023 cycles of the Canadian Health Survey on Children and Youth (CHSCY). The CHSCY is a national cross-sectional survey that collects health-related data on children and youth aged 1 to 17 years living in private dwellings in Canada. The 2019 cycle included all provinces and territories. However, the 2023 cycle included the 10 provinces only. In this report, we excluded the territories from the 2019 results to align with the 2023 CHSCY survey coverage. The master data file was used for these analyses.

Both survey cycles excluded children and youth if they were:

The survey collected data via self-reported questionnaire. Questionnaires were given to both:

The 2019 sample included children and youth aged 1 to 17 years as of January 31, 2019. The full, unweighted sample size was 39,951. The response rates were:

The 2023 sample included children and youth aged 1 to 17 years as of January 31, 2023. The full unweighted sample size was 69,522. The response rates were:

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Variables

Information about the variables included, by order of appearance in the report.

Long-term conditions

We identified long-term conditions if the PMK responded “yes” to "Has this child been diagnosed with any of the following long-term conditions?" for each of the specified conditions:

  • asthma
  • diabetes (including type 1 or type 2 diabetes, excluding prediabetes)
  • epilepsy
  • an anxiety disorder (such as a phobia, obsessive-compulsive disorder, or a panic disorder)
  • a mood disorder (such as depression, bipolar disorder, mania, or dysthymia)
  • an eating disorder (such as anorexia nervosa or bulimia)
  • a learning disability or disorder
  • attention deficit disorder or attention deficit hyperactivity disorder (ADHD)
  • autism spectrum disorder (also known as autism, autistic disorder, Asperger’s disorder or pervasive developmental disorder)
  • fetal alcohol spectrum disorder (FASD)

Children and youth had “any long-term condition” if they:

  • were identified as having at least 1 of the listed conditions or
  • indicated they had “been diagnosed with any other long-term physical, mental, developmental or intellectual conditions that are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional”

We refer to the second option as “other” long-term condition in the report. No further specifics were available on what this “other” condition was.

The survey included allergies in the list of long-term conditions in the CHSCY in 2023 but not in 2019. For this reason, we excluded allergies from the 2023 definition of “any long-term condition” for consistency throughout the report.

Some conditions were only asked to the PMK of children and youth aged 5 to 17 years due to these diagnoses being less relevant for young children. These conditions include:

  • mood disorder
  • eating disorder
  • anxiety disorder
  • learning disability or disorder

The rest were asked of the PMK of all children and youth aged 1 to 17 years.

Sex
Sex of the child or youth at birth (male or female), reported by the PMK.
Age
Age of the child or youth at the time of the survey, grouped into the following age groups: 1 to 4, 5 to 11, and 12 to 17 years.
Geographic region

We used geographic regions instead of individual provinces in certain cases to reduce variability of estimates and improve reportability of results. The geographic regions used were:

  • Ontario
  • Quebec
  • British Columbia
  • Prairies (Alberta, Saskatchewan, Manitoba)
  • Atlantic (New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador)
Family income
We obtained total family income through record linkage done by Statistics Canada. In this report, we divided income into quintiles based on the entire 2023 sample. We excluded individuals with negative family income from the analysis by income.
Household education

We determined highest household education by responses to the question: “What is the highest certificate, diploma or degree that this person has completed?” We used the highest level of education between the child or youth’s PMK and PMK spouse (if applicable) in this question.

Responses were categorized as:

  • high school diploma or equivalency certificate or less
  • certificate or diploma (trades, college or CEGEP, non-university and university below the bachelor’s level)
  • bachelor’s degree or higher
Place of residence
We classified respondents as living in an urban area (population centre) or a rural area. Statistics Canada defined population centres based on the 2021 Census. They include “continuously built-up areas having a population concentration of 1,000 or more and a population density of 400 or more per square kilometre.” We classified respondents living outside of a population centre as living in a rural area.
Ethnicity and race

The Employment Equity Act defines visible minority as "persons, other than Aboriginal peoples, who are non-Caucasian in race or non-white in colour." Accordingly, we categorized respondents as a visible minority or not a visible minority based on population group.

Visible minority includes children and youth whose PMK identified them as:

  • Arab
  • Black
  • Korean
  • Filipino
  • Chinese
  • Japanese
  • West Asian
  • South Asian
  • Latin American
  • Southeast Asian
  • Visible minority not included elsewhere or multiple visible minorities

Not a visible minority includes those whose PMK identified them as:

  • white
  • Indigenous
  • Arab and white
  • West Asian and white
  • Latin American and white

Refer to the Visible Minority and Population Group Reference Guide for more information.

Immigration status

We defined immigration status as immigrant family or non-immigrant family, as reported by the PMK of the child or youth. A child or youth from an immigrant family was any child or youth born:

  • outside of Canada
  • in Canada whose PMK or PMK spouse (if applicable) were born outside of Canada

We defined non-immigrant families as children or youth born in Canada with both PMK and PMK spouse (if applicable) also born in Canada.

Indigenous
We categorized children or youth as First Nations, Métis or Inuk (Inuit) based on the PMK response to the question: “Is this [child] an Aboriginal person, that is, First Nations (North American Indian), Métis or Inuk (Inuit)?” Note that in cases where multiple Indigenous identities were indicated, we counted the child or youth under each group. For example, we categorized those indicating both First Nations and Métis identity as both First Nations and Métis.
Self-rated general health
We defined high self-rated general health as youth aged 12 to 17 years who responded “excellent” or “very good” to the question: “In general, how is your health?”
PMK-reported child general health
We defined high PMK-reported child general health as children aged 1 to 11 years whose PMK responded “excellent” or “very good” to the question: “In general, how is this child’s health?”
High self-rated mental health
We defined high self-rated mental health as youth aged 12 to 17 years who responded “excellent” or “very good” to the question: “In general, how is your mental health?”
High PMK-reported child mental health
We defined high PMK-reported child mental health as children aged 1 to 11 years whose PMK responded “excellent” or “very good” to the question: “In general, how is this child’s mental health?”
High life satisfaction
We defined high life satisfaction as youth aged 12 to 17 years who responded a “9” or “10” to the question: “Using a scale of 0 to 10, where 0 means “very dissatisfied” and 10 means “very satisfied”, how do you feel about your life as a whole right now?”
High happiness
We defined high happiness as youth aged 12 to 17 years who responded they are usually “Happy and interested in life” to the question “How would you usually describe yourself…?”
Movement behaviours

We based physical activity, recreational screen time and sleep recommendations on the Canadian 24-Hour Movement Guidelines.

Sleep duration

The Canadian 24-Hour Movement Guidelines recommend that children ages 5 to 13 get 9 to 11 hours of sleep per night and youth ages 14 to 17 get 8 to 10 hours per night. The survey assessed whether children got this much sleep by asking several questions about the time children and youth typically fell asleep and woke up on weekdays and weekends. We used this information to determine total sleep duration.

Recreational screen time

We classified children and youth as meeting the recreational screen time recommendation if they spent 2 hours or less on recreational screen time on a typical day. The survey assessed this by asking a question about the total hours on a typical day the child or youth spent using electronic devices while sedentary.

Physical activity

We classified children and youth as meeting the physical activity recommendation if they got an average of 60 minutes of physical activity per day. The survey assessed this by asking several questions about the total amount of time children and youth engaged in physical activities each day, in the past 7 days.

Functional difficulty

We assessed functional difficulties using the Washington Group and United Nations Children's Fund Child Functioning Module. This module assesses difficulties in those aged 2 to 17 years across the domains of:

  • anxiety
  • seeing
  • hearing
  • playing
  • walking
  • learning
  • self-care
  • depression
  • remembering
  • making friends
  • concentrating
  • fine motor skills
  • communication
  • accepting change
  • controlling behaviour

We classified a child or youth as having difficulty if their PMK selected “a lot of difficulty” or “cannot do” for the given domain. For the variable “any functional difficulty,” we took all of the domains into account.

In this report, we also used the Washington Group Short Set (WG-SS) to report on functional difficulties. It includes specific functional difficulties from the complete list in the domains of communication, hearing, seeing, walking, remembering, concentrating and self-care.

The survey only asked some domains to the PMK of children or youth aged 5 to 17 years. The rest were asked of all children or youth aged 1 to 17 years (age group covered noted in each domain in Figure 4 of Determinants and outcomes).

Analysis

We weighted all estimates in this report to represent the population age 1 to 17 living in the 10 Canadian provinces. We used the bootstrap method to calculate variance estimates, including 95% confidence intervals (CIs). We removed respondents from the territories in 2019 from the study sample to align with the 2023 CHSCY population. For all variables above, we removed respondents with missing responses for a variable from each individual analysis. The only exception was the functional difficulty variables. We included those who were missing because they chose not to answer the question in the denominator of the calculated proportions, as recommended by Statistics Canada.

All differences mentioned in this report were statistically significant. To determine whether differences between 2 independent estimates were statistically significant, we compared the associated 95% CIs. We considered non-overlapping 95% CIs between estimates statistically significantly different.

The release guidelines differ between the 2019 and 2023 CHSCY cycles.

For 2019, estimates with a coefficient of variation (CV) between 15.0% and 35.0% were accompanied by an “E” to indicate caution due to high sampling variability. Any estimates with a CV over 35.0% weren’t reportable and noted with an “F.” Any estimates based on an unweighted numerator sample size under 10 weren’t reportable and noted with an “X.”

For 2023, any estimates with a small denominator were accompanied by an “E” to indicate caution or an "F" if the denominator size was too small to report. We applied thresholds for denominator sizes per Statistics Canada’s guidelines based on the population included in the estimate of interest. The full guidelines are available in the 2023 CHSCY User Guide. Estimates with an unweighted numerator sample size under 10 weren’t reportable and noted with an “X.”

You can find more information on disclosure control from Statistics Canada.

All of the estimates presented in this report are crude estimates. Age-standardized estimates are often used for comparisons over time or across different geographical areas or provinces. We performed an age-standardized sensitivity analysis. We only presented only crude estimates since the:

In this report, prevalence was reported by sex. We also explored including prevalence by gender. The results were only presented by sex given:

Limitations

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