1. Computing SubLHIN Population Projections in the South East Region August 2014 Update

2. Why Population Projections at SubLHIN level?  Planning health services cannot be accomplished with only LHIN level data. Variation in socio-economic, health status, health behaviors and access patterns exists at SubLHIN geography.  Population projections serve as the basis for determining the future demand for services.

3. Approach for Computing Projections  Designed for review and comparison with municipal planning initiatives  Methodology  Cohort component with migration and MOF adjustments  Cohort component with migration but no MOF adjustment  (Options without migration are no longer considered) MOF: Alignment to projections from Ontario Ministry of Finance

4. Projection Specifications  Period  Census Years - 2011, 2016, 2021 (ReCAP)  Interpolate annually for inter-census periods 2012-2015 and 2017- 2020  Geography  SE LHIN 15 SubLHIN regions, 7 Health Links  Sex  Age group (0-4, 5-9, …, 80-84, 85+)

6. Cohort Component Method  Assumes components of population change remain constant for the duration of the projection  Main components are mortality, fertility and migration  To project age/sex population cohort P t+n, n year period after census at time t, where census population cohort is P t, subtract estimated deaths (D), add estimated births (B) and add estimated net migration (M) P t+n = P t – D + B + M  Extend method for subsequent periods  Method can also consider changes in employment, labour force, industry or housing (not currently implemented).  Original methodology reviewed by Dr. Eric Moore, Retired Professor of Demography, Queen’s University (Recap 2008)

7. Data Sources  CSD level census counts – 2001, 2006 and 2011  Statistics Canada  CSD level population estimates – 2006-2013  Ministry of Finance (Intellihealth)  CD and LHIN level population projections – 2013-2021  Ministry of Finance (Intellihealth)  CSD level death counts– 2002-2011  Ontario Registrar General (Intellihealth)  CSD level birth counts– 2007-2011  Ontario Registrar General (Intellihealth)

8. Projecting the Survived Population  In order to have sufficient representation, mortality (and survival) was computed at the Health Link level using an aggregation of deaths over a 5 year period (2006-2010)  Health Link mortality rates were applied to respective SubLHINs  Mortality rates were based on the average annual number of deaths and the average annual population. A Five-year survival rate is calculated.  Assume overall 5 year age group survival rates apply to individual ages within group (except <1 year and 85+)  Apply survival rates to population estimates for 2011 and survived population for subsequent years

9. Calculating Mortality Rates  2011 Data quality issues – data not used  Downward trend: use most recent 5 years instead of 10 years

10. Survival Rates (%) by Health Link (Data Source: Ontario Vital Statistics Death Database 2006-2010)

11. Projecting Births  Estimate average annual age-specific fertility rates and sex ratio at birth by region/sex/age group using most currently available birth data (2007 to 2011 from Ontario Registrar General)  Assume computed age-specific fertility rates and sex ratio remain constant for the projection period  Assume overall 5 year age group fertility rates apply to individual ages within group  Apply fertility rates to surviving women of child bearing age to determine expected number of births  Apply sex ratio to distribute expected number of births by sex and subLHIN (2007 – 2011 births)  Apply survival rates to expected male and female births to determine final projected number of births  Apply Perth, Smiths Falls fertility rates for Lanark Highlands (Champlain LHIN)

12. Age-specific Fertility Rates by SubLHIN, 2007-2011

13. Adjustment for Census Under coverage  Census is affected by net under coverage error: difference between under coverage (people who are missed) and over coverage (people counted more than once or should not be counted)  The 2011 Census Estimates from Stats Canada are already adjusted for net under coverage and no further adjustments are made for projections.

14. Projecting Net Migration using Residual Method  Estimate average annual rate of net migration by region/sex/age group using population difference between 2006 and 2011 census, after accounting for births and deaths  Assume net migration rates remain constant for the projection period  Assume 5 year age group net migration rates apply to individual ages within group  Apply net migration rates to survived population and projected number of births

15. South East SubLHIN Net Migration Rates (%), 2006-2011

16. Additional Adjustments  Separate projections for Tyendinaga Mohawk (previously incompletely enumerated in Census) is no longer necessary. Census 2011 has made the adjustment for incomplete enumeration.  Projections computed using growth rates 2006-2011

17. Additional Adjustments  Alignment to projections from Ontario Ministry of Finance  Requirement to ensure comparability with other computations at provincial level  Align/ reconcile subLHIN projections on County level if possible (only Prince Edward County relates to subLHIN 1:1)  The balance of the subLHINs is reconciled to balance of LHIN projections by the MOF.  Lanark Highlands (Champlain LHIN) projections are not reconciled with MOF (data not available)

18. Computing Projections for Intermediate Years  Compute Projections using cohort component method for 2011, 2016 and 2021  Assume constant growth by subLHIN, sex and age group for inter-censal periods.

19. Population Projections for SE LHIN Comparisons of 3 sets of projections  Final Proj (2012): After MOF reconciliation (to LHIN level projections)  Before MOF reconciliation (2014): based on births, deaths and migration only  Final Proj 2014: After MOF reconciliation (to LHIN level projections, PEC to County level projections)

20. Population Projections for SE LHIN Comparisons of 3 sets of projections by subLHIN, age group and year (2012, 2016, 2021) 1 of 5

21. Population Projections for SE LHIN Comparisons of 3 sets of projections by subLHIN, age group and year (2012, 2016, 2021) 2 of 5

22. Population Projections for SE LHIN Comparisons of 3 sets of projections by subLHIN, age group and year (2012, 2016, 2021) 3 of 5

23. Population Projections for SE LHIN Comparisons of 3 sets of projections by subLHIN, age group and year (2012, 2016, 2021) 4 of 5

24. Population Projections for SE LHIN Comparisons of 3 sets of projections by subLHIN, age group and year (2012, 2016, 2021) 5 of 5

25. Population Projections for SE LHIN Results

26. Please forward any questions or comments to: Dirk Hogewoning Database Developer & Decision Support Consultant South East Local Health Integration Network Email: dirk.hogewoning@lhins.on.ca