Quarterly Digest
Volume 10 - Number 1 October 2000

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

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

• Vital Event Statistics - January 1, 2000 - March 31, 2000 and Year-to-date
  (Population, Livebirth, Death, Marriage, Stillbirth, Infant Deaths)

• Selected Birth Statistics - January 1, 2000 - March 31, 2000 and Year-to-date
  (Low Birthweight, Preterm, Teenage Mother, Elderly Gravida, Cesarean Section)

• External Causes of Death - January 1, 2000 - March 31, 2000 and Year-to-date
  (Accidents - [Motor Vehicle Accidents, Poisoning, Falls, Burns/Fire, Drowning, Other], Suicide, Homicide, Other External Causes)

• Neoplasm Deaths - January 1, 2000 - March 31, 2000 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, 2000 - March 31, 2000 and Year-to-date
  (Rheumatic/Valvular, Hypertension, Ischemic, Conductive & Dysrhythmic, Heart Failure, Congenital, Other)

• Respiratory Disease Death Statistics - January 1, 2000 - March 31, 2000 and Year-to-date
  (Emphysema, COPD, Pneumonia, Influenza, Asthma, Lung Disease from External Agents, Pulmonary Fibrosis, Other Respiratory)

• Other Selected Death Statistics - January 1, 2000 - March 31, 2000 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:
  Tuberculosis and Mycobacterium: Impact on Mortality in British Columbia, 1990 to 1999
  by Z. Kashaninia

• Glossary

• Editor's Note

• Contributors' Note

• Readers' Note

Preface

The vital event data provided here is also the first in Canada to have been derived from the newly introduced 10th 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 effect comparative counts. The greatest impact on statistical consistency is not due to the additional detail (approximately 2,000 new codes) afforded by ICD-10. Of greater significance are some major changes in the rules used to select the single underlying cause of death (UCOD) - most notably as relates to cancers and pneumonias. This Agency, concerned about the impact, medical validity, and interpretation of certifier intent of the new rules, has initiated an extensive daily editing of automated systems that has resulted in construction of two data sets - the primary (edited) for more accurate and consistent use in BC. As a result of this process, within BC, there are minimal differences in year 2000 statistical counts relative to historical data. Upcoming publications of the Quarterly Digest will provide issue/discussion papers relating to the impact of the introduction of the new coding system on specific year 2000 data and the approach being taken in BC.

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 2000 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.

This quarter's feature article descriptively examines the impact on mortality (caution re. small numbers) - both directly and indirectly, of tuberculosis, the late effects of old TB, and of mycobacterium. While there is no evidence, in terms of mortality, of any substantial increase of the direct or indirect involvement of TB through the 1990s, steady declines since mid-century have leveled off in the last decade. Mycobacterium has been increasingly noted as an opportunistic condition on death records - especially as a proportion of AIDS deaths. This article looks at these three conditions for age, gender, regional and Aboriginal mortality patterns. This report focus is entirely on mortality, and no inference regarding incidence or efficacy of treatment should be made.

Requests for changes, suggestions for article topics or contributions continue to be welcome. Your support and input into this publication is greatly appreciated.

R.J. Danderfer	Soo-Hong Uh
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

Tuberculosis and Mycobacterium: Impact on Mortality in
British Columbia, 1990 to 1999

Introduction

In Canada, the number of deaths from TB has decreased significantly since the 1960s; however, the number of deaths has remained the same through the 1990s. In British Columbia, the pattern has been the same. In 1960, 63 individuals died from TB while in 1999, the number was reduced to 20 (including deaths from late effects of TB), which has more or less remained the same for the past decade. From 1990 to 1999, 175 individuals died directly from TB or its late effects while another 394 individuals died from other causes but also had TB at the time of their death.

This report provides an analysis of all TB and TB-related deaths including deaths from late effects of TB in British Columbia from 1990 to 1999. A regional analysis based on age, gender and regional differences as well as Age Specific Death Rates, Age Standardized Mortality Rates (ASMRs) and Standardized Mortality Ratios (SMRs) are provided. In addition, the report presents a section on TB among the Status Aboriginal population in the Province. Finally, a special section is devoted to mycobacterium, which is closely associated with TB for which all original death records from 1990 to 1999 were retrieved and examined.

Methodology

Data were extracted on the basis of ICD-9 codes as indicated for deaths directly due to TB/mycobacterium (i.e. based on UCOD) and deaths for which TB/mycobacterium was considered to have contributed to the death (indirect). The combination of direct and indirect TB deaths is referred to as TB-related.

Age Standardized Mortality Rates (ASMRs) are a summary of age adjusted death rates by genders that are standardized to a specific population to compare different time periods or geographical locations. The Vital Statistics data that are used in this report are standardized to 1991 Canada Census population.

The ICD codes for TB deaths for this study are:

0100-0189		Tuberculosis
1370-1374		Late effects of Tuberculosis
0310-0319		Mycobacterium

Standardized Mortality Ratios (SMRs) are the ratio of the actual number of deaths in a Local Health Area (LHA) or region to the expected number of deaths in that area based on provincial, age-specific mortality rates. (SMRs are used for comparing each LHA's observed TB or mycobacterium death to the Province as a whole.)

The identification of Status Aboriginals was based on probabilistic record linkage of British Columbia Vital Statistics Agency death files, Medical Services Plan (MSP) Registration and Premium Billing files and the Registered Indian Status Verification file from Indian and Northern Affairs (INAC), Medical Services Branch, Health Canada.

Historical Background

Figure 1
Tuberculosis Deaths
British Columbia, 1890 to 1999

• A total of 131 individuals (69 males, 62 females) died as a direct result of TB between 1990 and 1999.

• The highest number of male and female deaths occurred in 1993 and 1997 respectively with 11 deaths.

• Since 1996, direct deaths from TB has stayed relatively the same for males with slight fluctuations while for females the number of deaths dropped in the latter two years.

Note: Does not include deaths from late effects of TB.

• Between 1990 and 1999, 258 individuals (174 males and 84 females) died directly of other causes but had TB at the time of their death.

• Over the period, for each death directly due to TB, there were two additional deaths in which TB was a contributing factor.

• An indirect TB death was twice as likely to be a male. The highest number of indirect TB deaths for both males and females occurred in 1998 (25 males and 15 females). The lowest number of indirect TB deaths for males was 11 in 1993 while for females, the lowest number was 2 deaths in 1992.

• In every year during the study period, male indirect TB deaths far surpassed the number of female deaths.

• A total of 44 individuals (19 males, 25 females) died as a direct result of the late effects of TB.

• No female deaths from the direct late effects of TB were reported in 1992 and 1998 and no male deaths were reported in 1997.

• Except for 1991, 1993 and the two years of 1992 and 1998 (where there were no female deaths reported) females had a higher number of deaths from late effects of TB than males in all the remaining years during the period of study.

• From 1990 to 1999, a total of 136 individuals (84 males, 52 females) died directly of other causes but had late effects of TB at the time of their deaths.

• The highest number of deaths from indirect late effects of TB for males occurred in 1994 with 15 deaths while the highest number of deaths for females occurred in 1991 with 9 deaths.

• With the exception of 2 years (1991 and 1999), more males than females died of indirect late effects of TB in every year during the period of the study.

• The highest rate of death related to TB was for those aged 85 and over (1.32 per 10,000 population). The lowest rate was 0.02 for both age groups of less than one and those aged 25-29.

• Except for one female death under the age of one, male deaths related to TB surpassed female deaths in every age group during the ten-year period of the study.

• No TB related deaths were reported for those aged 1 to 24 over the 10 year time period.

• Males and females aged 25-29 had the lowest TB related death rate. No female TB death was reported for those aged 35-39 during the years of 1990-1999.

• The risk of dying from/with TB increased with age for both males and females after age 60. In addition, males were twice as likely to die of TB in this age group than females.

• From 1990 to 1999, no deaths related to the late effects of TB were reported for males under the age of 30 and for those aged 35-39. No female deaths from the same were reported for those under the age of 54.

• Males had a much higher death rate involving late effects of TB than females in every age group.

• Males aged 85 and over and females 80-84 had the highest rate of late effect of TB related death.

• The lowest death rate for males was at 0.01 for age groups of 30-34, 40-44, 45-49 and 50-54. The lowest rate for females was 0.01 for those aged 55-59.

• TB related Age Standardized Mortality Rates (ASMRs) were higher for males than females for all the years from 1990 to 1999.

• The highest ASMR for males occurred in 1990 (0.19) and for females, the highest rate was 0.10 in 1997.

• The lowest ASMR for both males and females occurred in 1994 at 0.10 and 0.03 respectively.

• The Age Standardized Mortality Rates (ASMRs) for late effects of TB related deaths were higher for males than females from 1990 to 1998. However, the female ASMR showed a four-fold increase in the last year of the study to equal the male ASMR in 1999.

• The highest ASMR for males occurred in 1994 (0.09) while the highest ASMR for females was in 1991(0.05).

• The lowest ASMR for males was 0.04 for both years of 1998 and 1999 and for females was at 0.01 for both years of 1997 and 1998.

• In 1998 and 1999, males had their lowest ASMR from late effects of TB, while by 1999, females matched the male rate for the first time in the ten year period.

• Based on Standardized Mortality Ratios (SMRs), the regions of Vancouver (2.28) and North West (2.20) showed statistically significantly higher TB related deaths than were expected.

• The areas that showed significantly fewer TB deaths than were expected were East Kootenay (0.26)*, Capital (0.47), Central Vancouver Island (0.55), South Okanagan - Similkameen (0.61), and South Fraser Valley (0.69). *Caution, based on less than 5 deaths.

Note: SMR - standardized mortality ratio (Observed/Expected).
Rows that are shaded black indicate a statistically significantly high difference between the observed and expected deaths (p<0.05, two tailed), and rows that are shaded grey indicate a statistically significantly low difference between the observed and expected deaths (p<0.05).
Excludes non BC residents.

• With the SMR value of 1.42, Vancouver was the only region in the Province that showed statistically significantly higher deaths related to late effects of TB than were expected. None of the regions were identified as having statistically significantly fewer deaths than expected.

Aboriginal Population and Tuberculosis Mortality

• From 1991 to 1998, a total of 30 Status Aboriginal people died as a direct or indirect result of TB, which accounted for an overall 10 percent of all TB related deaths. 1995 showed the highest number of Aboriginal TB deaths with 6 deaths (16.2 percent of all TB related deaths). The lowest number of deaths occurred in 1998 with 2 deaths (4.1 percent of the total deaths).

• Although the number of deaths appear to be low, their significance should not be underestimated considering that the Status Aboriginal population is approximately 4 percent of the total BC population.

• From 1991 to 1998, a total of 13 Aboriginal deaths involved (directly or indirectly) the late effects of TB. No deaths were reported for 1992, 1996, and 1998.

• The highest proportion of deaths was in 1995 with 17.6 percent of all late effects of TB related deaths being Aboriginal. The lowest was 9.5 percent in 1993.

• The Status Aboriginal population in the province had a much higher age specific death rate of TB related mortality in every age group compared to the rest of the population. No deaths were reported for those aged 1 to 24 years of age.

• The highest age specific death rate related to tuberculosis was for those aged 75 and over for both groups. For this age group, the rate for Aboriginals was slightly over 7 times higher than the non Aboriginal group of population (9.77 and 1.36 respectively).

• The lowest Status Aboriginal age specific rate of TB related mortality was for those aged 25 to 29 at 0.11. This rate was still more than 5 times higher than the rate for the non-aboriginal group (0.02).

Note: ASMR - Age Standardized Mortality Rate per 10,000 standard population (1991 Canada Census).

• The Age Standardized Mortality Rates (ASMRs) for the aboriginal population were much higher for every year during the period of the study than the rest of the population in the Province. Overall, the Status Aboriginal rate was slightly over 7 times higher.

• The highest ASMR for the Aboriginal population was 1.04 in 1995, which was 13 times higher than the non-Aboriginal population. The lowest ASMR for this group was 0.30 for 1998, which was almost 3 times higher than the non-Aboriginal population.

• In terms of ASMR, over the short eight year period, neither population demonstrated an increasing or decreasing pattern.

Mycobacterium

For the purpose of this project, all the death records for Mycobacterium were retrieved and examined closely. The detailed information provided is the result of manual examination of original records.

• Between 1990 and 1999, a total of 17 individuals died directly from Mycobacterium (12 males and 5 females).

• Of the 17 deaths, 13 were 65 years of age or over. Other than one male death aged 25, no deaths for those under 30 years of age were reported as a direct result of Mycobacterium.

• Of all the direct mycobacterium deaths, 6 individuals had other respiratory diseases such as chronic bronchitis, asthma or emphysema. Death records also showed five cases of tobacco abuse and one case of alcohol abuse.

• The majority of the deaths (13 deaths) were caused by Mycobacterium Avium while the other 4 were identified as atypical (drug-resistant) mycobacterium.

• A total of 301 individuals (277 males, 24 females) died of other causes but had Mycobacterium at the time of their death.

• The highest number of indirect Mycobacterium deaths occurred in 1994 with 49 deaths (44 males and 5 females). The lowest number of deaths were 13 (12 males and 1 female) for both years of 1997 and 1998.

• Over 89 percent (279 of the total 301 deaths) of those who had Mycobacterium at the time of their deaths died of AIDS. The death records also showed 13 cases of IV drug abuse, 16 cases of tobacco abuse and 4 cases of alcohol abuse.

Note: Rate per 10,000 age specific populations. Excludes non residents.

• No direct deaths from Mycobacterium were reported for those under 25, as well as those in the age groups of 35-39, 45-49 and 55 to 69.

• The highest rate of death for direct Mycobacterium was for those aged 85 and over.

• The highest age specific death rate as an indirect result of Mycobacterium was for those aged 35 to 39.

• The age specific death rate for indirect Mycobacterium deaths was substantially higher than direct mortality for every age group except those aged 85 and over where the rate was equal for both direct and indirect deaths.

• Indirect Mycobacterium deaths showed much higher age specific death rates for those aged 25 to 50 while the direct deaths showed higher rates for those 70 years of age and over.

• The Age Standardized Mortality Rates (ASMRs) for Mycobacterium related deaths were higher (in some years, more than 20 times higher) for males than females.

• The highest ASMR for males occurred in 1993 and 1994 (0.24) while the highest ASMR for females was in 1994 (0.03).

• The lowest ASMR for males was 0.06 in 1998 while for females it was 0.01 in 1992, 1997 and 1998. No female deaths related to Mycobacterium were reported in 1990.

• Based on Standardized Mortality Ratios (SMRs), the regions of Vancouver City Centre (11.61), Vancouver Downtown East Side (4.58), and Vancouver West Side (2.63) showed statistically significantly higher Mycobacterium related deaths than were expected.

• The regions of Prince George (0.12)*, Coquitlam (0.14)*, Maple Ridge (0.17)*, Central Okanagan (0.18)* and Surrey (0.38) showed statistically significantly fewer deaths than were expected.
  *Caution, based on less than 5 deaths.

• Between 1990 and 1999, 14.9 percent of all those who died of AIDS, also had Mycobacterium on their death records.

• The highest percentage of AIDS deaths with Mycobacterium was 22 percent in 1999 and the lowest was 9 percent in 1990.

Summary and Conclusion

During the study period of 1990 to 1999, it was observed that more males than females died as a direct and indirect result of TB. Although lower than the rest, deaths from direct and indirect TB were shown for those 25 to 50 years of age while for late effects of TB, there were very few deaths among the same age groups. Male Age Standardized Mortality Rates were always higher than females as well as late effects of TB with the exception of 1999.

TB deaths among Status Aboriginals were found to be significant (10 percent of all TB deaths). Aboriginal population aged 60 and over had a much higher chance of dying from TB and its late effects than non-aboriginal groups. Age Standardized Mortality rates for the Aboriginal populations who died from TB were higher than the non-aboriginal population in every year. Although the rate dropped sharply in 1998, it was still almost over 3 times higher than the non-Aboriginal population rate.

Mycobacterium deaths (direct and indirect) were higher for males than females at all times. Almost all (89 percent) of those who had Mycobacterium at the time of their death died of AIDS. Of these individuals, those aged 35 to 39 had the highest rate of death.

Although the number of deaths from TB and Mycobacterium have been relatively low and stable in the past five years, they should be closely monitored as the number of immune compromised individuals continue to increase in the Province.

Glossary

Age Standardized Mortality Rate (ASMR):
A summary of age adjusted death rates by gender which have been standardized to a specific population for the purpose of rate comparisons of different time periods or different geographical locations. ASMRs in this report are per 10,000 standard population (1991 Canada Census).

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.

Standardized Mortality Ratio (SMR):
The ratio of the number of deaths occurring to residents of a geographic area (e.g. LHA) to the expected number of deaths in that area based on provincial age specific mortality rates.

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 other commitments and focus on ICD-10 issues, routine edits and corrections of missing and invalid postal codes were a bit delayed this year. As a result, there are slightly more than the usual number of live births and deaths for BC residents in this quarter that could not accurately be assigned to Local Health Area (see Table 1A). Some of these (27 births and 49 deaths) were known to be in Vancouver but sub-region was not identifiable. Another 24 live births and 9 deaths were known to reside in BC but the LHA could not be assigned. These few remaining unassigned events will be updated in the next quarter and reflect in year-to-date totals in the next "Quarterly" issue.

As noted in the preface to this edition, all provincial vital statistics offices began using the new revised WHO [American Adaptation] coding system (ICD-10) beginning with year 2000 data. This Agency has identified a few issues, most notably as relates to pneumonia and cancer coding and UCOD selection (papers to follow) that, if accepted, would have a major effect on statistical consistency . A daily editing and review of automated coding by medically trained staff was initiated at the outset of ICD-10 use for quality assurance, assessment of certifier intent, and historical consistency. As a result, statistical mortality data for use in BC is not as markedly affected by the switch to ICD-10 as is occurring in other jurisdictions. Unedited data continue to be sent to Ottawa for National use. Obviously, some changes such as removing certain conditions from one chapter area to another (e.g. some neurological or hematological conditions that are now considered neoplastic or perinatal and obstetrical tetanus now considered infectious) have an unavoidable effect especially when grouping conditions or conducting multiple code analyses. However, these types of code changes have relatively little impact and can be easily documented. Please see the Glossary for new ICD-10 listings used for the standard tables in this report and notes regarding any new inclusions or exclusions in the code groups.

Contributors' Note:

The editorial staff would like to invite any readers 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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