Quarterly Digest
Volume 11 - Number 1 September 2001

• Preface
  
  
• Map: B.C. Local Health Areas

• British Columbia: Local Health Areas (LHA) within Health Regions

• Vital Event Statistics - January 1, 2001 - March 31, 2001 and Year-to-date
  (Population, Livebirth, Death, Marriage, Stillbirth, Infant Deaths)

• Selected Birth Statistics - January 1, 2001 - March 31, 2001 and Year-to-date
  (Low Birthweight, Preterm, Teenage Mother, Elderly Gravida, Cesarean Section)

• External Causes of Death - January 1, 2001 - March 31, 2001 and Year-to-date
  (Accidents - [Motor Vehicle Accidents, Poisoning, Falls, Burns/Fire, Drowning, Other], Suicide, Homicide, Other External Causes)

• Neoplasm Deaths - January 1, 2001 - March 31, 2001 and Year-to-date
  (Lung, Female Breast, Colorectal, Other G.I., Female Reproductive, Prostate, Blood/Lymph, Other Malignancy, Nonmalignant and Unspecified)

• Heart Disease Deaths - January 1, 2001 - March 31, 2001 and Year-to-date
  (Rheumatic/Valvular, Hypertension, Ischemic, Conductive & Dysrhythmic, Heart Failure, Congenital, Other)

• Respiratory Disease Death Statistics - January 1, 2001 - March 31, 2001 and Year-End
  (Emphysema, COPD, Pneumonia, Influenza, Asthma, Lung Disease from External Agents, Pulmonary Fibrosis, Other Respiratory)

• Other Selected Death Statistics - January 1, 2001 - March 31, 2001 and Year-to-date
  (Diabetes, Alcohol-Related, AIDS, Other Infectious Disease, Cerebral and Other Vascular, Liver Disease, Amyotrophic Lateral Sclerosis and Multiple Sclerosis, Alzheimer's Disease, Parkinson's Disease)

• Summary Article:
  The Use of Vital Statistics Data by a Social Policy Ministry - Revisited
  by L.T. Foster, M. Shinto & W. Wei

• Glossary

• Editor's Note

• Contributors' Note

• Readers' Note

Preface

The vital event data provided in this issue have been derived from the newly introduced tenth revision of the International Classification of Diseases (ICD-10). ICD code groupings used in this publication for standard cause of death tables have been "translated" from ICD-9 to ICD-10 and the glossary provides complete new code listings and a note of the few minor inclusions/exclusions that could affect comparative counts.

Due to the fact that Vital Statistics Agency files are continually being updated, totals compiled by addition of the annual quarters will not correspond exactly to year-to-date and year-end figures. For the same reason, depending on the date the data are extracted, there may be differences in numbers presented in the year-end Quarterly Digest and those eventually reported in the 2001 Annual Report. Therefore, the numbers provided in this publication should be considered provisional. Finally, the usual cautions regarding random fluctuations in values, particularly those involving small numbers, must be noted.

The feature article in this quarter entitled The Use of Vital Statistics Data by a Social Policy Ministry - Revisited was provided by the Ministry of Children and Family Development. Thank you to L. T. Foster, M. Shinto and W. Wei for this brief discussion on the importance of vital statistics data to the programs of a Social Policy Ministry. It has long been the goal of this Agency to maximize the application of the best vital event data available for population monitoring and program evaluation not only within the Health Ministries but also in a variety of other areas. This paper aptly demonstrates how vital statistics data can contribute to an improvement of health and quality of life for BC's children.

As always, requests for changes and suggestions or contributions for articles continue to be welcome. Your support and input into this publication is greatly appreciated.

R.J. Danderfer	Soo-Hong Uh
CEO/Director	Manager
British Columbia	Information and Resource
Vital Statistics Agency	Management Branch
	Vital Statistics Agency

[Return to Table of Contents]

British Columbia
Local Health Areas

British Columbia:
Local Health Areas (LHA)
within Health Regions

The Use of Vital Statistics Data by a Social Policy Ministry - Revisted

The Ministry for Children and Families three-year performance plan⁵ has several key vital statistics indicators to help measure the ministry's performance. These include: healthy birth weights; survival rates for newborns; age standardized death rates for children (0 to 18 years); death rates for children related to natural causes and external causes (in BC, the Children's Commission reviews the deaths of ALL children in the province, so vital statistics data are extremely important for this purpose); SIDS death rates; alcohol-related death rates; and drug induced death rates (MCF has responsibility for addictions programs and services in BC). The indicators assist in tracking how progress is being made and whether targets are being met. The development of the targets also relies heavily on the trend data available for these indicators from the Vital Statistics Agency (VSA).

Over the past couple of years, MCF has relied on vital statistics data in its endeavour to target limited new funds to those geographical areas with greatest need. MCF programs and services are delivered through eleven administrative regions. As indicated in 1998¹, needs for services vary substantially among regions because of a variety of factors. New funds have been allocated amongst regions based on agreed-to definitions of "need". The characteristics of "need", however, are defined in part by vital statistics data, socioeconomic factors and demographic factors. For example, new funding provided for addictions was allocated partly on the basis of addictions related death rates, existing service levels and population size. Similarly, new funds for children's early intervention programs was allocated on the basis of number of children between the ages of 0 to 6, and need factors as defined by vital statistics data. This involved the use of data from the Health Status Registry⁶, a registry which reports congenital defects and special needs and disabling conditions for the 0 - 19 age group in the province, and other vital statistics data related to birth records (e.g. low birth weight).

New funds for general programs for children and families are also now allocated based partly on population characteristics and vital statistics data. It must be noted, however, that getting agreement among proposals within MCF and external stakeholders about which indicators to use and what weights should be given to these indicators is no easy matter. It requires scientific evidence, objective data (provided by VSA) and a lot of discussion!

MCF is responsible for providing child protection and family support services in BC. Close to 40% of all children-in-care in the province are currently aboriginal. With the province's goal of moving services for aboriginal children and families to aboriginal agencies, it is imperative that MCF has good information that can identify aboriginal clients. Records are not always accurate with respect to identifying aboriginal heritage. By data matching children-in-care records with Status Indian data available through VSA, the Ministry for Children and Families is able to get the best data possible on the aboriginal status of children-in-care. Preliminary data matching has already indicated that the number of aboriginal children-in-care in BC has been under-recorded. Getting the best data will assist MCF as it moves services to aboriginal agencies and will help ensure, as much as possible, the provisions of culturally appropriate services to aboriginal clients when required. Seven of the 18 vital statistics indicators in MCF's Performance Plan⁵ are specifically related to the Status Indian population (Table 1).

Other joint projects between VSA and MCF are currently underway. A major study, which looks at vital statistics records for children-in-care, is assisting MCF in getting a better understanding of the health needs of children who come into care. For example, through a cooperative endeavour between the Provincial Health Officer, the Children's Commission, the Ministry for Children and Families and the Vital Statistics Agency, a major review⁷ has just been completed on children's deaths in the province, with special attention being given to specific groups such as children-in-care and Status Indian children. Also, a couple of chapters in a forthcoming book on children's health and well-being in BC⁸ have been co-authored by MCF and VSA staff. One chapter looks specifically at SIDS deaths and trends in the province, while another examines the general trends in children's health status, including Status Indian children, within the province.

The Ministry for Children and Families continues to use an increasing quantity of vital statistics data. This is facilitated by the marketing strategy undertaken by VSA with respect to vital statistics data and the needs of MCF. A formal Memorandum of Understanding between the two agencies deals with expectations and resource requirements and will allow cooperative ventures to continue well into the future. Both agencies have a joint goal of using the best information available to help improve the health of children and families in the province. Hopefully improvements can be made across Canada through a better understanding of how vital statistics data can be used to improve population health and quality of life.

Works Cited

1. Shaw, Kelly T. and Foster, Leslie T. (1998). The use of vital statistics data by a social policy ministry. Vital News, Summer (?), p. 5
   
2. Budget Transparency and Accountability Act (2000).
   www.legis.gov.bc.ca/2000/amend/gov02-2.htm
   
3. Ministry for Children and Families (2000). Measuring our success - a framework for evaluating population outcomes, 2nd ed. www.mcf.gov.bc.ca/publications/measure_success/msindex_1.htm
   
4. Ministry for Children and Families (1999). Strategic plan for aboriginal services. www.mcf.gov.bc.ca/aboriginal_strategic_services_1.htm See also: Ministry for Children and Families (2001). Historic agreement with first nations leaders. News Release, March 22
   
5. Ministry for Children and Families (in press). Performance plan 2001/2 to 2003/4. www.gov.bc.ca/mcf/
   
6. British Columbia Vital Statistics Agency (2001). Health Status Registry, Ministry of Health, Victoria, BC.
   
7. Kendall, P. R. W. Health status of children and youth in care in British Columbia: What do the mortality data show? Ministry of Health, Victoria, BC
   
8. Foster, L. T. and Hayes, M. V. (in press). Too little to see - too big to ignore: children's health and well-being in BC. Western Geographical Series, University of Victoria, Victoria, BC

Note: This article was originally published in Vital News for the Vital Statistics Council for Canada. Since publication, the Ministry for Children and Families (MCF) is now referred to as the Ministry of Children and Family Development. References to the Ministry of Health are for what is now the Ministry of Health Services.

Glossary

Alcohol-Related:
This category includes all deaths considered as being directly or indirectly related to alcohol as indicated by inclusion by the certifier of selected alcohol identifying conditions anywhere on the death record (including "lifestyle" field). It should be noted that where alcohol is an indirect cause of death (i.e. not UCOD) and the direct underlying cause of death falls within one of our selected causes (e.g. motor vehicle accidents), then this death may be counted in both columns. That is, not all of "alcohol-related" are exclusive. This category includes ICD-10 codes: F100-F109, K700-K709, O993, P043, O354, Q860, G312, G621, G721, I426, K292, K860, X45, X65, Y14, T510-T512, T519. Note: now excludes acute pancreatitis, and cirrhosis not specifically identified as alcohol induced.

Assignment of Health Region:
Cases are assigned to Health Regions by the aggregation of appropriate LHAs.

Assignment of Local Health Area (LHA):
Allocation of LHA, in the case of births and deaths is based upon the usual residence (by postal code) of the mother and deceased respectively. Marriages are assigned to LHAs according to the place of event. Community name, is used in the absence of postal code.

Elderly Gravida:
Any mother who was 35 years of age or older at the time of delivery of a live born infant.

External Causes of Death:
Deaths due to environmental events, circumstances and conditions as the cause of injury, poisoning, and other adverse effects. Broad categories include accidents, suicide, medical or abnormal reactions (considered accidents), homicide, legal intervention, misadventures (counted as accident) and injury from war operations. Standard "Quarterly" tables under this heading include deaths due to accidents, suicide, homicide, and other. Accidents are subdivided by the following categories; motor vehicle accidents (MVA) (ICD-10 V020-V049, V090-V092, V093, V120-V149, V190-V196, V200-V249, V260-V349, V360-V449, V460-V549, V560-V649, V660-V749, V760-V799, V803-V805, V820-V821, V823-V839, V840-V875, V877-V8999, Y850), poisoning (X40-X49), falls (W00-W19), burns/fire (X00-X19), drowning (V900-V909, V920-V929, W65-W74), other accidents (V010-V019, V050-V069, V091, V099, V100-V119, V150-V189, V198-V199, V250-V259, V350-V359, V450-V459, V550-V559, V650-V659, V750-V759, V800-V802, V806-V819, V822, V876, V910-V919, V930-V949, V950-V978, V98-V99, W20-W64, W75-W99, X20-X39, X50-X59, Y40-Y849, Y859, Y86, Y880-Y883). Suicide ICD-10 codes are X60-X84, Y870; homicide (X85-Y09, Y871); "other [external]" consists of events of undetermined intent, legal interventions, and operations of war (Y10-Y369, Y890-Y899).

Note: the late effects of accidental poisoning, falls, and burns/fire are no longer identified separately for inclusion in these categories and are now part of "other accidents"). Trains are now considered motor vehicles in ICD-10 but for consistency, have been excluded from MVA counts to still be considered as "other transport".

Heart Disease:
Tables under this heading include deaths due to:

• rheumatic/valvular: (I050-I099, I340-I38)
  
• hypertension/hypertensive: (I10-I159)
  
• ischemic: (I200-I259) (Note: now includes cardiomyopathy specified as ischemic)
  
• conductive & dysrythmic: (I440-I499)
  
• heart failure: (I500-I509)
  
• congenital: (Q200-Q249)
  
• other: pulmonary (I260-I289), inflammatory (I300-I339, I400-I409), cardiomyopathy (I420-I429)(Note: now excludes ischemic),
  other ill-defined or unspecified heart disease (I510-I519)(includes myocardial degeneration)

ICD-9:
The ninth revision of International Classification of Diseases, World Health Organization, Geneva, 1977. An internationally used system of approximately 12,000 four (and some three) digit numbers representing a system of categories to which morbid entities are assigned according to an established criteria. ICD provides a common basis of disease and injury classification that facilitates storage, retrieval, and tabulation of statistical data.

ICD-10:
The tenth revision of International Classification of Diseases and Related Health Problems, World Health Organization, 1992. In use beginning with year 2000, update of ICD-9 revised with alpha-numeric system and increased code detail (approximately 18,000). The BC Vital Statistics Agency and all their provincial counterparts utilize an ICD-10 that has been modified by the National Center for Health Statistics (NCHS) for use in the classification and analysis of medical mortality data in the United States (October, 1998).

Infant Deaths:
Deaths of children under one year of age.

Live birth:
The complete expulsion or extraction from its mother, irrespective of the duration of the pregnancy, of a product of conception in which, after the expulsion or extraction, there is:

• breathing;
  
• beating of the heart;
  
• pulsation of the umbilical cord; or
  
• unmistakable movement of voluntary muscle, whether or not the umbilical cord has been cut or the placenta attached.

Low Birth Weight:
Any liveborn infant weighing less than 2500 grams.

Neoplasms (ICD-10 C000-D489):
Although the vast majority of deaths in this category are due to malignant cancer, also included are benign, in-situ, and unspecified "tumours". Detailed ICD-10 breakdown used in "Neoplasm Deaths" tables are;

• lung: includes trachea, bronchus, lung and pleura (C33, C340-C349, C384, C450). Note: now excludes mesothelioma of lung and trachea.
  
• female breast: (C500-C509)
  
• colorectal: (C180-C218)
  
• other G.I.: includes esophagus, stomach, small intestine and duodenum, liver & intrahepatic bile ducts, gallbladder and extrahepatic ducts, pancreas, peritoneum, other and ill-defined within digestive organs (C150-C179, C220-C269)
  
• female reproductive: includes uterus, cervix, placenta, ovary and adnexa, vagina & external genitalia (C510-C58)
  
• prostate: C61
  
• blood lymph: includes lymphatic and haematopoietic tissue (C810-C969, C463).
  
• other malignancy: includes malignant neoplasms of other (e.g. lip, oral cavity, pharynx, nose, ear, larynx, heart, bone and connective tissue, urinary tract, eye, brain, endocrine glands)and ill-defined or unspecified sites (C000-C148, C300-C449, C451-C462, C467-C499, C600-C609, C620-C768, C5099*, C80*). Note: * codes used exclusively by BC Vital Statistics Agency for male breast cancer and for unknown primary site cancer.
  
• non-malignant & unspecified: includes benign, in-situ, and neoplasms of uncertain or unknown behaviour (D000-D489).
  Note: This neoplasm group now includes myeloproliferative disease, thrombocythemia, monoclonal gammopathy, and lymphoproliferative disease which were not previously considered neoplastic in ICD-9 and were counted in other ICD chapters.

Other Selected Death Statistics:
Tables under this heading include deaths due to:

• diabetes (E100-E149).
  
• alcohol related - see above.
  
• AIDS/HIV: (B200-B24).
  
• other infectious and parasitic disease: (A000-B199, B250-B999) Note: Now includes obstetrical and neonatal tetanus.
  
• cerebro and other vascular disease: (I600-I698, I700-I879, I950-I959, I880-I899, I970-I979, I99). Includes cerebrovascular disease, disease of arteries and veins, hypotension, and other circulatory system disease. Note: "Other circulatory system disease" now includes post procedural disorders of the circulatory system (I970-I979) which are never selected as the UCOD. However they are confirmed by editing and either recoded to the more specific disease (embolism, stroke, M.I.) or double coded if the complication is confirmed.
  
• liver disease: (K700-K7699). Note: Now includes toxic liver disease with cholestasis.
  
• ALS/MS: Amyotrophic lateral sclerosis and multiple sclerosis: (G122, G1221, G35). Note: In order to maintain continuity with ICD-9, unspecified motor neuron disease (G122) is included in this category as it was previously not distinguishable from ALS.

Premature/Pre-term:
Any live born infant less than 37 weeks gestation at delivery.

Respiratory Disease Death Statistics:
Tables under this heading include deaths due to the following:

• emphysema: (J430-J439) Note: Now excludes when described as or resulting in obstructive disease -see note at COPD.
  
• COPD: (440-J449). Note: Now includes specific code within the group for COPD when accompanied with acute lower respiratory infection, or with acute exacerbation. This inclusion has no statistical impact on UCOD. Also, this category now includes asthma and emphysema described as obstructive not previously included in ICD-9.
  
• pneumonia: (J120-J181, J188-J189) Note: ICD-10 has a new code for chlamydial pneumonia (J160). It is uncertain if this condition would have previously been coded to "pneumonia due to other specified bacteria" (ICD-9 4828) or to "other diseases due to viruses and chlamydia" (0788), or to both. This disease is very rare on death records so if not coded to 4828, the impact to comparison of historical data would still be minimal. Daily VS edits have been implemented to unsure consistent selection of pneumonia.
  
• influenza: (J100-J118)
  
• asthma: (J450-J459, J46) Note: Now excludes when described as obstructive - see note at COPD.
  
• lung disease due to external agents: (J60-J709)
  
• pulmonary fibrosis: (J841)
  
• other respiratory diseases: (J00-J069, J182, J200-J42, J47, J80-J840, J848-J9899) Note: Now includes post procedural respiratory disorders (J950-J959) which formerly used to be injury codes. These codes are never selected as the UCOD so their impact would only effect multiple code analyses. The Vital Statistics Agency includes these in daily data edits to confirm them as post procedural and to double code for the specific respiratory condition (e.g. pneumonia). As a result, respiratory disease statistics in BC are more consistent with historical data.

Stillbirth:
The complete expulsion or extraction from its mother after at least twenty weeks of pregnancy or after attaining a weight of at least 500 grams, of a product of conception in which, after expulsion or extraction, there is no breathing, beating of the heart, pulsation of the umbilical cord or unmistakable movement of voluntary muscle.

Teenage Mother:
Any mother who was age 19 or less at the time of delivery.

UCOD:
Underlying cause of death - based upon application of standard international coding rules for determining sequential relationships of conditions and diseases from immediate cause backwards to underlying cause.

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Editor's Note:

Due to a new Government cost constraint directive, the Quarterly Digest, beginning with Volume 10, Number 4 (last quarter of year 2000) will only be published at the BC Vital Statistics web site. Regular subscribers should have received notification of availability and information regarding distribution options.

Please note that changes have been made to the grouping of ICD-10 codes for motor vehicle accident (MVA). Codes used in year 2000 erroneously did not include some motor vehicles involved with a train which were counted instead in the "other transport" category. MVA counts provided in year 2000 Quarterlies should be minimally (if at all) affected as excluded codes concerned only motor vehicle/train events in which the victim's mode of transport was not specified.

Contributors' Note:

The editorial staff would like to invite any researchers of health-related topics who wish to contribute an article or paper summary for publication in this Quarterly Digest to contact the Information and Resource Management Branch of the British Columbia Vital Statistics Agency. Articles should focus on health status issues in British Columbia. It is preferable that submissions be in "electronic media" format (e.g. Word, Word Perfect, Excel, Power Point, Corel, Pagemaker, etc.). Article presentation will be subject to space allowances and publishing deadlines.

Readers' Note:

Re: "Letters to the Editor", or mailing and distribution.

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