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B.C. Home » Ministry of Health » Vital Statistics Agency » Statistics and Reports » Quarterly Digest » Third and Fourth Quarter of 2001

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

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

• Vital Event Statistics - July 1, 2001 - September 30, 2001 and Year-to-date
  (Population, Livebirth, Death, Marriage, Stillbirth, Infant Deaths)

• Selected Birth Statistics - July 1, 2001 - September 30, 2001 and Year-to-date
  (Low Birthweight, Preterm, Teenage Mother, Elderly Gravida, Cesarean Section)

• External Causes of Death - July 1, 2001 - September 30, 2001 and Year-to-date
  (Accidents - [Motor Vehicle Accidents, Poisoning, Falls, Burns/Fire, Drowning, Other], Suicide, Homicide, Other External Causes)

• Neoplasm Deaths - July 1, 2001 - September 30, 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 - July 1, 2001 - September 30, 2001 and Year-to-date
  (Rheumatic/Valvular, Hypertension, Ischemic, Conductive & Dysrhythmic, Heart Failure, Congenital, Other)

• Respiratory Disease Death Statistics - July 1, 2001 - September 30, 2001 and Year-to-date
  (Emphysema, COPD, Pneumonia, Influenza, Asthma, Lung Disease from External Agents, Pulmonary Fibrosis, Other Respiratory)

• Other Selected Death Statistics - July 1, 2001 - September 30, 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)

• Vital Event Statistics - October 1, 2001 - December 31, 2001 and Year-end
  (Population, Livebirth, Death, Marriage, Stillbirth, Infant Deaths)

• Selected Birth Statistics - October 1, 2001 - December 31, 2001 and Year-end
  (Low Birthweight, Preterm, Teenage Mother, Elderly Gravida, Cesarean Section)

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

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

• Heart Disease Deaths - October 1, 2001 - December 31, 2001 and Year-end
  (Rheumatic/Valvular, Hypertension, Ischemic, Conductive & Dysrhythmic, Heart Failure, Congenital, Other)

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

• Other Selected Death Statistics - October 1, 2001 - December 31, 2001 and Year-end
  (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: Accidental Falls Mortality in British Columbia, 1990-2000
  by Z. Kashaninia

• Glossary

• Index of Quarterly Digest Articles to date

• Contributors' Note

• Readers' Note

Preface

This "Quarterly's" standard tables of vital event data are for the third quarter of year 2001, to-date September 30, 2001 and for the fourth quarter, with year-end data. These tables are the earliest year 2001 British Columbia live birth, death, marriage and stillbirth statistics to be provided in publication.

Mortality data in year 2000 and 2001 Quarterly Digests are the first available in Canada to have been derived from the tenth revision of the International Classification of Diseases (ICD-10). ICD code groupings used in these publications 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 the 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" 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 issue is Accidental Falls Mortality in British Columbia. There were more than 3800 deaths as a direct result of an accidental fall in British Columbia between 1990 and 2000. In addition, a fall was an indirect factor in the deaths of 4442 individuals who died of other causes. This article examines deaths both directly and indirectly due to falls. It begins with a regional analysis based on age, gender and regional differences as well as an analysis based on type of fall, site of the fall and whether the fall was alcohol related.

This edition of the Quarterly Digest marks the last one in which the geographic designation of "Health Region" will be used. Beginning with the first quarter of 2002, the new geographical entities of "Health Service Delivery Areas" (HSDA) and "Health Authorities" (HA) will come into use in all Vital Statistics publications. The "Local Health Area" designation will remain unchanged.

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 CEO/Director British Columbia Vital Statistics Agency

Soo-Hong Uh Manager Information and Resource Management Branch British Columbia Vital Statistics Agency

[Return to Table of Contents]

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British Columbia
Local Health Areas

[Return to Table of Contents]

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

01 East Kootenay LHA 01 Fernie 02 Cranbrook 03 Kimberley 04 Windermere 05 Creston 18 Golden 02 West Kootenay-Boundary LHA 06/07 Kootenay Lake/Nelson 09 Castlegar 10 Arrow Lakes 11 Trail 12/13 Grand Forks/Kettle Valley 03 North Okanagan LHA 19 Revelstoke 20 Salmon Arm 21 Armstrong-Spallumcheen 22 Vernon 78 Enderby 04 South Okanagan-Similkameen LHA 14 Southern Okanagan 15 Penticton 16 Keremeos 17 Princeton 23 Central Okanagan 77 Summerland 05 Thompson LHA 24 Kamloops 26 North Thompson 29 Lillooet 30 South Cariboo 31 Merritt 06 Fraser Valley LHA 32 Hope 33 Chilliwack 34 Abbotsford 75 Mission 76 Aggassiz-Harrison

07 South Fraser Valley LHA 35 Langley 36 Surrey 37 Delta 08 Simon Fraser LHA 40 New Westminster 42 Maple Ridge 43 Coquitlam 09 Coast Garibaldi LHA 46 Sunshine Coast 47 Powell River 48 Howe Sound 10 Central Vancouver Island LHA 65 Cowichan 66 Lake Cowichan 67 Ladysmith 68 Nanaimo 69 Qualicum 70 Alberni 11 Upper Island/Central Coast LHA 71 Courtenay 72/84 Campbell River/ Vancouver Island West 83 Central Coast 85 Vancouver Island North 12 Cariboo LHA 25 100 Mile House 27 Cariboo-Chilcotin 28 Quesnel 49 Bella Coola Valley 13 North West LHA 50 Queen Charlotte 51 Snow Country 52 Prince Rupert 53 Upper Skeena 54 Smithers 80 Kitimat 87/94 Stikine/Telegraph Creek 88 Terrace 92 Nisga'a

14 Peace Liard LHA 59 Peace River South 60 Peace River North 81 Fort Nelson 15 Northern Interior LHA 55/93 Burns Lake/Eutsuk 56 Nechako 57 Prince George 16 Vancouver LHA 161 Vancouver City Centre 162 Vancouver Downtown East Side 163 Vancouver North East 164 Vancouver West Side 165 Vancouver Midtown 166 Vancouver South Unknown Vancouver 17 Burnaby LHA 41 Burnaby 18 North Shore LHA 44 North Vancouver 45 West Vancouver-Bowen Island 19 Richmond LHA 38 Richmond 20 Capital LHA 61 Greater Victoria 62 Sooke 63 Saanich 64 Gulf Islands

[Return to Table of Contents]

Accidental Falls Mortality in British Columbia, 1990-2000

by Z. Kashaninia

Introduction

Deaths from accidental falls account for over 40 percent of all accidental deaths in Canada. In addition, falls are also the leading cause of hospital admissions for accidental injury in Canada accounting for 68 percent of all days spent in the hospital. This figure increases to 95 percent for those aged 65 and over (CIHI Report).

In British Columbia, deaths from accidental falls account for 22.1 percent of all accidental deaths. Between 1990 and year 2000, in British Columbia, over 8000 individuals died directly or indirectly as a result of an accidental fall. The majority of falls occurred in individuals' homes primarily involving those over 65 years of age.

This report will provide an analysis of all accidental fall deaths from 1990-2000 in British Columbia. Throughout the report, there are references made to "Direct Deaths" which refer to all deaths that were caused directly by a fall and "indirect deaths" which refer to all individuals who had a fall but died of something other than the fall. "Direct" and "indirect" deaths combined are referred to as "fall related".

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) will be presented. An analysis based on type and site of the fall and whether the fall was alcohol related will also be provided. A special section at the end will be devoted to the Indian population and fall related deaths based on Vital Statistics data from 1991 to 1999.

The ICD codes for this study were based on ICD 9 (E8800-E888) and ICD 10 (W00-W19), the details of the codes used are as follows:

Falls	ICD - 10 (2000)	ICD - 9 (1990-1999)
Fall on same level	W00-W02, W04, W18	E885
Fall involving furniture	W05-W08	E8842
Fall involving playground equipment	W09	E8840
Fall on/from stairs	W10	E8800, E8809
Fall on/from a ladder	W11	E8810
Fall on/from scaffolding	W12	E8811
Fall from building/structure	W13	E882
Other fall from one level to another	W14, W17	E8831, E8832, E8839, E885
Fall from cliff	W15	E8841
Other specified fall	W03, W16	E8860, E8869, E8830
Unspecified fall	W19	E887, E888

Methodology

The British Columbia mortality data used in this report were obtained from Registrations and Medical Certifications of Death submitted to the British Columbia Vital Statistics Agency. All disease entities to 1999 were coded to the International Classification of Diseases 9^th Revision (ICD-9) with year 2000 data being coded to 10^th Revision (ICD-10). Code groupings have been reconciled and, since year 2000, edits of ICD-10 rule changes have been used to provide consistency over the time period.

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.

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 ratio of observed to expected deaths to the Provincial ratio of 1.

Data for the Status Indians were retrieved from the Indian Status Verification File (SVF) of First Nations and Inuit Health Branch, Health Canada originating from Department of Indian and Northern Development, the Status Indian Entitlement files from BC Medical Services Plan (MSP) and the BC Vital Statistics Agency.

• Between 1990 and 2000, there were 8247 direct and indirect accidental deaths involving a fall. Female deaths outnumbered male deaths in every year of the study period. Overall, females accounted for 57% of all fall related deaths.

• A total of 3825 individuals (1876 males, 1949 females) died directly of an accidental fall between 1990 and 2000. With 210 deaths, 1999 was the year with the highest number of deaths for males while females had their highest number of deaths in 1998 with 211 deaths.

• In addition to those dying directly of an accidental fall, 4422 individuals (1656 males and 2766 females) died indirectly from accidental falls. The highest number of females to die, as an indirect result of a fall was 332 in 1999 while the highest number of males was 181 in 1998.

• Over the time period, there was a general increase in the number of falls related (direct and indirect) deaths. This increase was driven by deaths (both male and female) where the fall was considered contributive but not the direct cause of death.

• Direct accidental fall deaths accounted for 22.1 percent of all accidental deaths in British Columbia between 1990 and 2000.

• For males, falls were the third highest cause of accidental deaths (15.9 percent) after motor vehicle accidents (33.1 percent) and poisoning which includes drug overdoses (25.5 percent).

• For females, accidental falls were the highest cause of accidental deaths (35.3 percent) with motor vehicle accidents being the second cause of accidental deaths (30.2 percent) and poisoning, the third (15.8 percent).

• More than one third of all accidental deaths for females were caused by an accidental fall.

• Accidental deaths for those under 65 and those over 65 showed markedly different patterns.

• Proportionately, the highest cause of accidental deaths for males under age 65 was motor vehicle accidents (37.0 percent) closely followed by poisoning (31.4 percent). Only 6.0 percent of all accidental deaths was caused by falls in this group. In contrast, falls were the cause of more than half (52.6 percent) of all accidental deaths for males aged 65 and over. Motor vehicle accidents were the second highest cause of accidental deaths for this group at 18.0 percent.

• The highest cause of accidental deaths for females under the age of 65 was motor vehicle accidents (45.6 percent) with poisoning being the second at 29.2 percent. Deaths from accidental falls were the cause of 5.2 percent of all deaths. In contrast for females 65 and over, accidental falls were responsible for 64.5 percent of all accidental deaths. Motor vehicle accidents were the second highest accidental deaths at 14.4 percent.

• Males had a higher age specific death rate in every age group except infants (less than one year of age) and those over 85 years of age where both male and female rates were equal or nearly equal.

• Males and females aged 85 and over had the highest risk of dying from an accidental fall.

• The risk of dying from an accidental fall began to increase substantially at the age of 65 for both males and females and reached its highest at the age of 85 and over.

• In terms of numbers, 90 percent of falls related (direct and indirect) deaths occurred at age 65 and older. For males, the age 65 and older proportion was 83 percent while females age 65 and older accounted for 96 percent of all female falls related deaths.

• In every year of the study, the age standardized mortality rates (ASMR) for males were much higher than females.

• The highest ASMR for males was 2.24 in 1990. For females, the highest ASMR was 1.75 in 1992.

• A slight downward trend in ASMRs from the late 1990s to year 2000 was seen for both males and females. This downward trend was primarily among males (2.24 to 1.55) while females experienced only a slight decline (1.57 to 1.41).

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

• Based on Standardized Mortality Ratios (SMRs), 8 areas showed statistically significantly more accidental fall deaths than were expected. These were: Revelstoke (2.00), Prince Rupert (1.63), Vancouver Downtown East Side (1.49), Trail (1.49), Peace River South (1.36), Alberni (1.28), Greater Victoria (1.24) and Prince George (1.23).

• Areas that showed statistically significantly fewer deaths than expected were: Golden (0.24), Windermere (0.31), Fernie (0.43), Grand Forks/Kettle Valley (0.63), Creston (0.67), Abbotsford (0.79), Vancouver North East (0.79), Richmond (0.81), Central Okanagan (0.82), Langley (0.83), Surrey (0.85), Vancouver West Side (0.86), and Vancouver South (0.88).

• Those 65 and over, had their highest number of accidental fall fatalities in the months of December and January, while for all those under the age of 20, the month of March, July and August showed the highest number of accidental fall fatalities.

• Those in the age groups of 20-49 and 50-64 also had their highest fall fatalities in the summer months of July and August respectively.

• Of all deaths due to falls between 1994 and 2000, 7.8 percent of records indicated alcohol involvement.

• 1996, 1997 and 2000 had a higher proportion of alcohol related deaths for accidental falls than the average over the time period.

• In six Local Health Areas more than 30 percent of their accidental fall deaths were alcohol related. These were Nisga'a (100 percent, but based on only one death), Kimberley (57.1), 100 Mile House (42.1), Windermere (33.3), Princeton (30.8), and Vancouver Downtown East Side (30.3).

• The type of fall for most accidental fall deaths was not specified on the majority of death records, which accounted for 75.9 percent of all accidental fall deaths.

• Six percent of the death records indicated stairs as the cause of the fall and 4.7 percent indicated a fall from one level to another, as the cause of death.

• Falls from the same level or those involving furniture accounted for 3.3 percent of the total accidental fall deaths.

• For the purposes of this project, data on place of injury from 1995 to 2000 were retrieved and where appropriate, original records were examined to determine the type of place where the fatal fall occurred.

• From 1995 to 2000, 2211 individuals died of an accidental fall. Of the total, 561 death records did not specify a place of injury (25.4 percent). The place of injury with the highest number of deaths (36.7 percent) was private homes with 812 deaths.

• 415 death records (18.8 percent) indicated nursing homes as place of injury while hospitals were the site for 5.0 percent of total falls.

• 160 falls (7.2 percent) occurred in the outdoors, such as park, river, lake and mountain sites while 81 deaths (3.7 percent) occurred on the street or highway (including adjacent sidewalks and pedestrian foot paths).

Accidental Falls (Direct and Indirect) among Status Indians in British Columbia

• Age standardized mortality rates for Status Indians were almost three times higher than the rest of the population for all the years between 1992 and 1999. ASMR value for the combined years of 1992 - 1999 was 3.35 for Status Indians as opposed to 1.70 for the rest of the population in British Columbia.

• Between 1991 and 1999, 180 Status Indians (98 males, 82 females) died of accidental falls (direct and indirect) in British Columbia.

• With 17 deaths, 1996 was the year with the highest number of male deaths while 1998 was the year with the highest number of female deaths with 16 deaths.

• Over the 10 years, the number of deaths were relatively similar between males and females except 1994 and 1996 where the number of male deaths exceeded females by more than three times.

• The risk of dying from a fall increased most notably for males between 70 and 74. For females, the risk of dying from an accidental fall increased by nearly 10 fold for those aged 75 and over.

• No Status Indian male deaths for those under the age of 15 were reported during the 10 year study period. Three females in the same age group were victims of accidental falls.

• Overall, 52 percent of all male Status Indian fall deaths were alcohol-related compared to 18.3 percent for females. Except for 1992, (where no alcohol-related fall deaths were reported) males had a higher proportion of fall-related deaths involving alcohol than females. 1996 had the highest proportion of alcohol involvement for both males and females at 76.5 and 50 percent respectively. No female alcohol-related deaths were reported for 1991 and 1992 and no male alcohol-related deaths were reported in 1992.
  
  [Click here to download a Microsoft Excel Spreadsheet of the above table]
  
  [Click here to download a Microsoft Excel Spreadsheet of the above chart]
  • Between 1994 and 1999, 41 percent of all accidental fall deaths for the Status Indian population of BC was alcohol-related compared to only 7.7 percent for the rest of the BC population.

  • At least one third to over 62 percent of all Status Indian accidental fall deaths involved alcohol while the figure for the rest of BC was from 6.8 to the highest of 9.0 percent.

  Summary and Conclusion

  In British Columbia, between 1990 and 2000, over 8000 individuals lost their lives due to fall related accidents. Of these deaths, 3825 deaths occurred directly due to a fall, accounting for 22 percent of all accidental deaths in British Columbia. In fact, accidental falls were the highest cause of accidental deaths for females and the third highest accidental death for males after motor vehicle accidents and poisoning.

  Accidental falls claimed more lives in the older age groups for both males and females. The risk of dying from an accidental fall was substantially higher for those 75 and over than for the younger groups. Winter months caused higher accidental fall deaths for the older age groups while spring and summer months proved more hazardous and deadly for the younger population.

  Close examination of death records from 1995 to 2000, revealed that the place of injury for most accidental fall deaths was private homes (36.7 percent) with injuries more than likely being a fall from stairs. 18.8 percent occurred in nursing homes and 7.2 percent occurred outdoors. Slightly over one quarter of all the records did not specify a site for the fall.

  The Status Indian population had a much higher risk of dying from an accidental fall than the rest of the population in British Columbia. Between 1992 -1999, the age standardized mortality rate (ASMR) was 3.35 compared to 1.70 for the rest of BC. Further, the age specific death rates for younger Status Indians were much higher than the entire Province (e.g. the age specific death rate for those aged 35-39 was 0.91 while the rate for the same age group for the entire BC population was 0.17). Alcohol was also a much more significant factor for Status Indians as 41 percent of all their fall death records indicated alcohol use/abuse compared to 7.7 percent for the rest of the Province.

  Glossary

  [Return to Table of Contents]

  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 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.

  [Return to Table of Contents]

  Index of Quarterly Digest Articles to date:

  Volume 1 - Number 1 & 2 - October 1991
  

  1. Alcohol Related Deaths.
     
  2. Status Indians in British Columbia, 1989 - A Vital Statistics Overview.

  Volume 1 - Number 3 - January 1992
  

  1. Fatal Poisonings in British Columbia - 1989 - by J.M. Macdonald.
     
  2. Fatal Head Injuries in British Columbia - 1990 - by J.M. Macdonald.

  Volume 1 - Number 4 - April 1992
  

  1. Mortality Mapping in British Columbia - by M.C.R. Edgell & L.T. Foster.
     
  2. Suicide Deaths in British Columbia, - by T.A. Tuk & J.M. Macdonald.
     
  3. Selected Health Status Indicators in British Columbia, 1985-1990 by K.F. Burr, L.T. Foster, & J.H. Mohamed.

  Volume 2 - Number 1 - July 1992
  

  1. Charting Birth Weight of British Columbia Newborns: How do we compare? - by W.J. Kierans.
     
  2. Cardiovascular Disease Death in British Columbia: Still number one - by J.M. Macdonald, T.A. Tuk & J.H. Mohamed.

  Volume 2 - Numbers 2 & 3 - November 1992
  

  1. A Deadly Affair: Cigarette Smoking - Attributable Deaths, British Columbia, 1985 and 1989 - by R.M. Strohmaier & W. Hu.
     
  2. Health Status Registry: A Health Planning Tool Revisited and Revitalized by W.J. Kierans & A.K. McBride.

  Volume 2 - Number 4 - February 1993
  

  1. Recent Advances in Community Health Related Information: A Vital Statistics Perspective - by T.A. Tuk, M.A. Collison, L.T. Foster.
     
  2. Cesarean Section Rates: A British Columbia Overview Prepared by Division of Vital Statistics.

  Volume 3 - Number 1 - May 1993
  

  1. Cancer Mortality in British Columbia Part I: Cancer as an Underlying Cause of Death - by C. Cranfield, T.A. Tuk & J.M. Macdonald.
     
  2. Estimates for Health Effects Attributable to Second-Hand Smoke in British Columbia - by M.E. Thomson.

  Volume 3 - Number 2 - August 1993
  

  1. Cancer Mortality in British Columbia Part II: Cancer Mortality Multiple Conditions - by J.M. Macdonald, T.A. Tuk & C. Cranfield.
     
  2. Technical Notes - An Alternative Approach to Mapping Mortality: A Bayesian Procedure - by Ying C. MacNab.

  Volume 3 - Number 3 - November 1993
  

  1. Injury Facts and Prevention Strategies for Children and Youth in British Columbia - by Office for Injury Prevention.
     
  2. Ethnicity and Health Status, Part One: The IndoCanadian Community - by W.J. Kierans.
     
  3. Technical Notes - Measurement of Mortality Part I: Crude Rate - by Ying C. MacNab & T.A. Tuk.

  Volume 3 - Number 4 - May 1994
  

  1. Ethnicity and Health Status, Part Two: The Chinese Immigrant Community - by W.J. Kierans.
     
  2. Potential Years of life Lost: British Columbia, 1985-1992 - by R.M. Strohmaier.
     
  3. Technical Notes - Measurement of Mortality Part II: Age Standardized Mortality Rate - by Ying Cai MacNab & T.A. Tuk.

  Volume 4 - Number 1 - June 1994
  

  1. Vital Statistics in British Columbia: An Historical Overview of 100 Years, 1891 to 1990 - by J.M. Macdonald.
     
  2. Technical Notes: Measurement of Mortality Part III: Standardized Mortality Ratio - by Ying Cai MacNab & T.A. Tuk.

  Volume 4 - Number 2 - August 1994
  

  1. Status Indians in British Columbia: A statistical Overview [1987-1992] - prepared by Medical Services Branch of Health Canada and BC Division of Vital Statistics.

  Volume 4 - Number 3 - November 1994
  

  1. Drug-Related Deaths in British Columbia: 1981 to 1993 - by T.A. Tuk and J.M. Macdonald.

  Volume 4 - Number 4 - February 1995
  

  1. Sudden Infant Death Syndrome in British Columbia: 1981 to 1993 - by H. Amershi.

  Volume 5 - Number 1 - May 1995
  

  1. AIDS/HIV Related Mortality in British Columbia: 1985 to 1994 - by N. Fast.

  Volume 5 - Number 2 - August 1995
  

  1. Suicide, Homicide, and Gun Deaths, British Columbia, 1985 to 1993 - by T.A. Tuk & J. Macdonald.

  Volume 5 - Number 3 - November 1995
  

  1. Respiratory Disease Mortality in British Columbia, 1985 to 1994 by Y.C. MacNab, J. Macdonald, T.A. Tuk.

  Volume 5 - Number 4 - March 1996
  

  1. Diabetes in Birth and Death: British Columbia, 1987 to 1994 - by K. Stenning.

  Volume 6 - Number 1 - July 1996
  

  1. Increased Maternal Age and the Outcome of Pregnancy: An eight year population based study, British Columbia, 1987 - 1994 by Y.C. MacNab, J. Macdonald, T.A. Tuk.

  Volume 6 - Number 2 - October 1996
  

  1. Marriage and Family in British Columbia: 1931 - 1994 - by Z. Kashaninia.

  Volume 6 - Number 3 - January 1997
  

  1. Accident Fatality in British Columbia, 1987 - 1995 [Introductory chapter of in progress longer report] - by E. Demaere.

  Volume 6 - Number 4 - April 1997
  

  1. A Review of Delivery Mode in British Columbia, 1987 - 1995 - by Y.C. MacNab.

  Volume 7 - Number 1 - July 1997
  

  1. Pregnancy Outcomes in British Columbia, - by Cathy Hull.

  Volume 7 - Number 2 - October 1997
  

  1. Women and Cancer: Lung and breast cancer among women in BC, 1974-1996 - by Z. Kashaninia.

  Volume 7 - Number 3 - January 1998
  

  1. Women and Cancer (Part II): Ovarian, uterine and cervical cancer among women in B.C., 1980 to 1996 - by Z. Kashaninia.

  Volume 7 - Number 4 - May 1998
  

  1. The Declining Trend of Sudden Infant Death Syndrome: Comparison with other major causes of infant mortality and deaths due to unknown causes, BC, 1985 to 1996 - by R. Fisk, J Macdonald, W. Vander Kuyl with editorial comments by S. Peck.

  Volume 8 - Numbers 1 & 2 - December 1998
  

  1. Animal Caused Fatalities, British Columbia, 1969 to 1997 - by R. Armour and J. Macdonald.

  Volume 8 - Number 3 - March 1999
  

  1. The Impact of Infectious Diseases on Mortality in BC, 1990-1997 - by Z. Kahsaninia.

  Volume 8 - Number 4 - August 1999
  

  1. Hepatitis Deaths in British Columbia, 1990-1998 - by Z. Kashaninia.

  Volume 9 - Numbers 1 & 2 - October 1999
  

  1. Drowning and Other Water-Related Accidental Fatalities, British Columbia, 1990 to 1998 - by Z. Kashaninia, J. Macdonald and R. Armour.

  Volume 9 - Number 3 - March 2000
  

  1. Fire Deaths in British Columbia, 1986 to 1998 - by Z. Kashaninia.

  Volume 9 - Number 4 - June 2000
  

  1. Beautiful and Deadly British Columbia: Natural Environmental Deaths, 1985 to 1998 - by T. Stubbings and J. Macdonald.

  Volume 10 - Number 1 - October 2000
  

  1. Tuberculosis and Mycobacterium: Impact on Mortality in British Columbia, 1990 to 1999 - by Z. Kashaninia.

  Volume 10 - Numbers 2& 3 - December 2000
  

  1. The Health Status Registry - adapted from original report by M. Silver.

  Volume 10 - Number 4 - July 2001
  

  1. The Impact of ICD-10 (in year 2000) on identifying, classifying, coding and UCOD selecting neoplasm(s) on death records - by J. Macdonald and R. Armour.

  Volume 11 - Number 1 - September 2001
  

  1. The Use of Vital Statistics Data by a Social Policy Ministry - Revisited - by L.T. Foster, M. Shinto and W. Wei.

  Volume 11 - Number 2 - October 2001
  

  1. Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's disease) Deaths in British Columbia to Year 2000 - by Z. Kashaninia, M. Marquette and S. Fricke.

  Volume 11 - Number 3 & 4 - May 2002
  

  1. Accidental Falls Mortality in British Columbia, 1990-2000 - by Z. Kashaninia.

  Topics in progress/planned
  

  1. Suicide in British Columbia, 1987-1999
     
  2. Leukemia Mortality in British Columbia, 1986-2000

  [Return to Table of Contents]

  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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