Quarterly Digest
Volume 13 - Number 3 February 2004

• Special Notice
  
  
• Map: B.C. Local Health Areas

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

• Vital Event Statistics - July 1, 2003 - September 30, 2003 and Year-to-date
  (Population, Livebirth, Death, Marriage, Stillbirth, Infant Deaths)

• Selected Birth Statistics - July 1, 2003 - September 30, 2003 and Year-to-date
  (Low Birthweight, Preterm, Teenage Mother, Elderly Gravida, Cesarean Section)

• External Causes of Death - July 1, 2003 - September 30, 2003 and Year-to-date
  (Accidents - [Motor Vehicle Accidents, Poisoning, Falls, Burns/Fire, Drowning, Other], Suicide, Homicide, Other External Causes)

• Neoplasm Deaths - July 1, 2003 - September 30, 2003 and Year-to-date
  (Lung, Female Breast, Colorectal, Other G.I., Female Reproductive, Prostate, Blood/Lymph, Other Malignancy, Nonmalignant and Unspecified)

• Heart Disease Deaths - July 1, 2003 - September 30, 2003 and Year-to-date
  (Rheumatic/Valvular, Hypertension, Ischemic, Conductive & Dysrhythmic, Heart Failure, Congenital, Other)

• Respiratory Disease Death Statistics - July 1, 2003 - September 30, 2003 and Year-to-date
  (Emphysema, COPD, Pneumonia, Influenza, Asthma, Lung Disease from External Agents, Pulmonary Fibrosis, Other Respiratory)

• Other Selected Death Statistics - July 1, 2003 - September 30, 2003 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)

• Glossary

• Contributors' Note

• Readers' Note

Special Notice

The 2003 Quarterly Reports currently posted at the Vital Statistics website present data for the 'old' geographical configurations. As soon as geographical updating is complete, the data for the 1^st and 2^nd quarters of 2003 will be re-run, and replacement tables showing data by the 'new' geographies will be posted here on the Vital Statistics website.

Andrew K. McBride	Terry Tuk
A/Chief Executive Officer	Director
British Columbia	Information and Resource Management Branch
Vital Statistics Agency	Vital Statistics Agency

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British Columbia
Local Health Areas

Local Health Areas within
Health Service Delivery Area & Health Authority

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 the ICD-10 codes: F100-F109, K700-K709, O993, P043, O354, Q860, G312, G621, G721, I426, K292, K860, X45, X65, T510-T512, T519. Note: now excludes acute pancreatitis, and cirrhosis not specifically identified as alcohol induced.

Assignment of Health Service Delivery Area (HSDA) and Health Authority (HA):
Cases are assigned to Health Service Delivery Areas and Health Authorities 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 the 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) (V020-V049, V090-V099, V120-V149, V190-V196, V200-V799, V803-V805, V820-V821, V823-V839, V840-V878, V880-V888, V8900-V8909, V8920-V8929, V8990-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, V879, V889, 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, I514), cardiomyopathy (I420-I429)(Note: now excludes ischemic), other ill-defined or unspecified heart disease (I312-I318, I510-I513, I515-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 live born 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 and 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, U049) 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: (J440-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 ensure 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 geographical 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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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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