Quarterly Digest
Volume 7 - Number 3 January 1998

• Preface
  
  
• Map: B.C. Local Health Areas
  
  
• British Columbia: Local Health Areas (LHA) within Health Regions
  
  
• Vital Events Statistics
  (Population, Livebirth, Death, Marriage, Stillbirth, Infant Deaths)
  
  
• Selected Birth Statistics
  (Low Birthweight, Preterm, Teenage Mother, Elderly Gravida, Cesarean Section)
  
  
• External Causes of Death
  (Accidents - [Motor Vehicle Accidents, Poisoning, Falls Burns/Fire, Drowning, Other], Suicide, Homicide, Other External Causes)
  
  
• Neoplasm Deaths
  (Lung, Female Breast, Colorectal, Other G.I., Female Reproductive, Male Reproductive, Blood/Lymph, Other Malignancy, Nonmalignant and Unspecified)
  
  
• Heart Disease Deaths
  (Rheumatic/Valvular, Hypertension, Ischemic, Conductive & Dysrhythmic, Heart Failure, Congenital, Other)
  
  
• Other Selected Death Statistics
  (Respiratory Diseases - [Emphysema, COPD, Pneumonia/Influenza, Other], Diabetes, Alcohol-Related, AIDS, Cerebral and Other Vascular, Liver Disease)
  
  
• Summary Article:
  Women and Cancer (Part II): Ovarian, uterine and cervical cancer among women in B.C., 1980-1996
  by Z. Kashaninia
  
  
  • Glossary
    
    
  • Editor's Note
    
    
  • Contributors' Note
    
    
  • Readers' Note
    
    
  
  

Preface

This "Quarterly’s" standard tables of vital event statistical information are for the third quarter of 1997 and, with year-to-date numbers providing nine months of 1997 birth, death, marriage, and stillbirth statistics, are the most up-to-date to be provided in publication.

To make "Quarterly" information more accessible and flexible, soon after hardcopy release, Quarterly Digest issues will continue to be made available at our web site, http://www.hlth.gov.bc.ca/vs/. All standard tables will also be made available on the Health Planning Database (HPDB).

Due to the fact that Vital Statistics Agency's 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 will be differences in numbers presented in this year's Quarterly Digests and those eventually reported in the Vital Statistics 1997 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 issue's feature article is the second part (Part I in Vol.7, No.2) that examines the impact of cancer on the women of British Columbia. Part one focused on cancer of the lung and of the breast. Part two examines female reproductive cancers which killed 312 women in British Columbia in 1996, with concentration on cancers of the ovary, uterus, and cervix. As before, this article provides overviews (BC numbers, incidence, age specific rates, provincial mortality comparisons). Because the number of deaths due to each of these cancers is relatively small especially when viewed at the Local Health Area (LHA) level, there is more focus in this article on descriptive findings in terms of the numbers of deaths and the characteristics of the women who died - such as, their age, resident community, occupation, country of birth.

British Columbia
Local Health Areas

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

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

I. Introduction and Overview

As discussed in Women and Cancer: Lung and Breast Cancer among women in B.C., 1974-1996 (Quarterly Digest, Vol. 7. No.2), cancer was the leading cause of death for women in British Columbia in 1996. In total, 3,368 women lost their lives to cancer; that is, more than one out of every four female deaths in British Columbia was caused by cancer

In 1996, 10 percent of all cancer deaths were caused by reproductive cancers which accounted for 312 deaths. In that year, more women died of ovarian cancer than any other type of reproductive cancer(59 percent of all reproductive cancer deaths). Uterine cancer accounted for 21 percent of all reproductive cancer deaths while cervical cancer accounted for 14 percent. The remaining 6 percent were caused by other female genital and reproductive cancers.

Figure 1
Deaths From Reproductive Cancers Among Women
British Columbia, 1996

This paper will focus on the three major types of reproductive cancers, namely, ovarian, uterine and cervical cancer from 1980-1996. Each type of cancer will be analyzed on a provincial and regional basis. A summary of important information on risk factors and prevention will also be provided. Finally, a detailed summary section of all 1996 major female reproductive cancer deaths for British Columbia will be provided.

Methodology

The British Columbia mortality data used in this report were obtained from the Registrations and Medical Certifications of Death submitted to the British Columbia Vital Statistics Agency. The underlying cause of death (UCOD) was coded to the International Classification of Diseases, 9th Revision (ICD-9). Cancers examined in this study were identified by ICD-9 codes of 183.0 (ovary), 179 and 182 (uterus), and 180 (cervix).

Age Standardized Mortality Rates (ASMRs) are a summary of age adjusted death rates by gender 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 1971 Canada Census female population.

The 1996 summary information and tables were provided by identification and examination of original Registrations and Medical Certifications of Death for all women who died of the three types of reproductive cancers in 1996.

Age Standardized Incidence rates were obtained from the British Columbia Cancer Agency annual reports. The incidence rates are based on the number of new cases of cancer per 10,000 for a fixed age and gender specific population. This rate eliminates the effect of the changing age structure of the population as a factor in determining risk of developing cancer; therefore, it is an appropriate measure to use when examining changes in risk over time. The 1971 Canada census female population was used as the standard for this data.

Provincial and national data were obtained from Statistics Canada reports. The ASMR measures that were used in these reports have been standardized to 1991 Canada female population.

It should be noted that age standardized rates are derived from 1971 (British Columbia Vital Statistics Agency and British Columbia Cancer Agency) and 1991 (Statistics Canada) Canada census population. Rates based upon different standards should not be compared.

II. Ovarian Cancer

The highest number of female reproductive cancer deaths are caused by ovarian cancer. The risk of developing ovarian cancer increases with age, family history of cancer, prolonged exposure to asbestos and talc, high fat diets and obesity, first pregnancy after age of 30, and the use of estrogen. If detected early, ovarian cancer is curable. Unfortunately, the symptoms are often vague and can be mistaken for less serious illnesses and therefore, the disease is generally not detected until it is in its advanced stages. There have been many attempts to screen for ovarian cancer but so far none have been successful. ²

Table 1
Female Deaths Due to Ovarian Cancer (ICD 183.0)
British Columbia, 1987 to 1996

• In 1996, 183 women died of ovarian cancer.

• From 1987 to 1996, a total of 1,709 women lost their lives to ovarian cancer. The highest number of women who died of ovarian cancer were in the age groups of 65-69,70-74 and 75-79.

Figure 2
Age Specific Deaths Rates for Ovarian Cancer
British Columbia, 1987 - 1996

Note: Rate per 10,000 age specific female population.

• The highest rate of ovarian cancer deaths were in individuals who were between 80-84 (6.33 per 10,000 age specific female population).

• Women in their 40s were almost three times more likely to die of ovarian cancer than those 39 or younger.

• The risk of dying from ovarian cancer increased with age up to age 84 and declined for those aged 85 and over.

Figure 3
Age Standard Incidence and Mortality Rates
For Ovarian Cancer
British Columbia, 1980 to 1994

Note: Shaded area represents the difference between incidence and mortality. Rate per 10,000 female standard population (using 1971 Canada Census population as a standard).
Source: BC Cancer Agency Annual Reports, 1980-1995.

• There was a sharp increase in the incidence rates for ovarian cancer in 1984 and 1991. Overall, since 1980, neither incidence nor mortality showed a notable decline.

• As with lung cancer, the symptoms of ovarian cancer do not often appear until the disease is in its advanced stages. Therefore, the gap between the incidence and mortality rates tends to be smaller than other types of cancers where early detection leads to a decrease in the number of deaths as is the case with breast cancer and cervical cancer for which the analysis will follow.

Table 2
Ovarian Cancer Deaths by Age Group and Local Health Area
British Columbia, 1987 - 1996

• A total of 1,709 women died of ovarian cancer from 1987 to 1996 in British Columbia. Women in the age group of 70-74 had the highest number of deaths from ovarian cancer.

• From 1987 to 1996, 33 women under the age of 40 died of ovarian cancer in British Columbia. Vancouver had the highest number of ovarian cancer deaths for women under the age of 40. Greater Victoria and North Vancouver were closely behind with 3 deaths in each area respectively.

National and Provincial Comparisons

Figure 4
Death Rates for Ovarian Cancer
Canada and Provinces, 1995

Note: Rate per 100,000 female population (using 1991 Canada Census female population).
Source: Canadian Cancer Statistics, National Cancer Institute, Statistics Canada.

• The crude death rate for ovarian cancer in Canada was 8.8 per 100,000 female population in 1995.

• Two provinces surpassed the national level of mortality with the highest being Nova Scotia at a rate of 10.5 followed by Ontario at 9.2. The rate for British Columbia was at 4.8, almost half of the national rate.

• At a rate of 3.5, Alberta had the lowest rate of ovarian cancer in the nation.

III. Uterine Cancer

With the exception of ovarian cancer, uterine cancer claims the lives of more women than any other type of reproductive cancer. So far, there are no screening tests available for early diagnosis of this type of cancer. Risk factors that are associated with uterine cancer consist of obesity, few or no children, late menopause and use of excess estrogen. ¹

Table 3
Female Deaths Due to Uterine Cancer (ICD 179, 182)
British Columbia, 1987 to 1996

• A total of 64 British Columbia women died of uterine cancer in 1996.

• Between 1987 and 1996, a total of 606 women died of uterine cancer. With the exception of 1988, women in either age group of 70-74 or 75-79 had the highest number of deaths from uterine cancer.

Figure 5
Age Specific Death Rates for Uterine Cancer
British Columbia, 1987 - 1996

Note: Rate per 10,000 age specific female population.

• The risk of dying from uterine cancer increased with age for women in British Columbia.

• The lowest age specific death rate for uterine cancer deaths was found in the younger age groups of 30-34 while the highest risk was among those aged 85 and over.

• The highest risk of death, relative to younger age groups, began at age 50 and continued to increase with age.

Figure 6
Age Standardized Incidence and Mortality Rates
for Uterine Cancer
British Columbia, 1980 to 1994

• The incidence rates for uterine cancer peaked at the highest level in 1988. From 1980 to 1994, both incidence and mortality rates have slightly decreased.

• There was a large gap between incidence rates and mortality rates indicating a better survival rate than ovarian cancer.

Table 4
Uterine Cancer Deaths by Age Group and Local Health Area
British Columbia, 1987 - 1996

• From 1987 to 1996, a total of 606 women died of uterine cancer in British Columbia. Like ovarian cancer, women in the age group of 70-74 had the highest number of deaths.

• As previously noted, the risk of dying from uterine cancer increases with age. Only 2 women under the age of 40 died of uterine cancer from 1987 to 1996.

National and Provincial Comparisons

Figure 7
Death Rates for Uterine Cancer
Canada and Provinces, 1995

• The crude death rate for uterine cancer in Canada was 4.3 per 100,000 female population in 1995.

• Among all provinces, Prince Edward Island had the lowest rate at 1.5. Newfoundland and Manitoba both had the highest level at 5.6. British Columbia had a rate of 4.1 which was just below the national level.

IV. Cervical Cancer

Cervical cancer is the most diagnosed form of reproductive cancer due to the development of pap tests. The pap test detects the changes in the cells of the cervix and can therefore define a precancerous stage called dysplasia (abnormality). Once dysplasia is treated, the patient is less likely to develop cervical cancer. Many studies have shown that the increase in the use of pap tests has significantly reduced the incidence and mortality of cervical cancer. Some of the risks associated with cervical cancer are HPV virus (a sexually transmitted disease), multiple sex partners, cigarette smoking, use of oral contraceptives, and low socioeconomic status. ¹⁰

Table 5
Female Deaths Due to Cervical Cancer (ICD 180)
British Columbia, 1987 to 1996

• A total of 45 women died of cervical cancer in 1996.

• Between 1987 and 1996, a total of 449 women died of cervical cancer. The highest number of deaths from cervical cancer occurred in 1995 with a total of 57 deaths.

Figure 8
Age Specific Death Rates for Cancer of the Cervix
British Columbia, 1987 - 1996

• The risk of dying from cervical cancer generally increased with age.

• Women in the 45-49 age group were twice as likely to die from cervical cancer than those who were 35 or younger.

• For women under the age of 40, the mortality rate from cervical cancer exceeds the rate of ovarian or uterine cancers.

Figure 9
Age Standardized Incidence and Mortality Rates
For Cervical Cancer
British Columbia, 1980 to 1994

• For cervical cancer deaths, there was a larger gap between incidence and mortality rates in British Columbia from 1984 to 1994 indicating a better chance of survival than other types of cancers such as ovarian or lung cancer.

• Incidence rates had their highest points in 1985 and the lowest in 1991. Mortality rates were highest in 1988, and were at their lowest level in 1992.

Table 6
Cervical Cancer Deaths by Age Group and Local Health Area
British Columbia, 1987 - 1996

• From 1987 to 1996, a total of 449 women died of cervical cancer in BC. As with the other two reproductive cancers, women in the age group of 70-74 had the highest number of deaths.

• For women under the age of 40, cervical cancer claimed more lives than any other reproductive cancer in British Columbia. (A total of 57 women under the age of 40 died of cervical cancer from 1987 to 1996). Although Surrey had the highest number of cervical cancer deaths for women under the age of 40, three areas had higher age specific rates (age 20-39). Surrey's rate of 0.16 per 10,000 female population was exceeded by Quesnel, Nanaimo and Richmond with rates of 0.76, 0.42 and 0.18 respectively.

National and Provincial Comparisons

Figure 10
Death Rates for Cervical Cancer
Canada and Provinces, 1995

• In 1995, the crude death rate for cervical cancer in Canada was 2.7 per 100,000 female population.

• Among all provinces, Prince Edward Island had the highest rate at 5.8 and Saskatchewan had the lowest rate at 1.4. British Columbia had a rate of 3.0 just above the national level.

Summary of information on all deaths from ovarian, uterine and cervical cancer in BC for 1996

The information provided below is descriptive of that obtained through manual identification and examination of original death documents.

Table 7
Number of Female Deaths from Ovarian,
Uterine and Cervical Cancers, British Columbia, 1996

• In 1996, 183 women died of ovarian cancer. The youngest woman to die of this disease was 25 and the oldest was 91. The majority of women who died of ovarian cancer were in their 70s. Almost half of all those who died were between 60-79.

• In the same year, 64 women died of uterine cancer. The youngest woman to die of this disease was 44 and the oldest was 97. The majority of women who died of uterine cancer in 1996 were in their 70s. There were no deaths from uterine cancer for age groups under 40 years of age.

• More than half of cervical cancer deaths included women in their 50s and under. The youngest woman to die of cervical cancer was 30 and the oldest was 81. This means that, for women aged 49 or younger, cervical cancer claimed more lives than any other type of reproductive cancer. In 1996, 16 women aged 49 or under died of cervical cancer as opposed to 15 deaths for ovarian cancer and only 2 deaths for uterine cancer.

Table 8
Place of Birth for Women Who Died of
Ovarian, Uterine and Cervical Cancer
British Columbia, 1996

• The majority of women who died of ovarian cancer in 1996 were born in other provinces of Canada (79). Forty three women were born in British Columbia and 23 were born in the United Kingdom.

• As with ovarian cancer, the majority of women who died of uterine cancer in 1996 were also born in other Canadian provinces (23). Twenty one women were born in British Columbia and 7 were born in the United Kingdom.

• Almost half of all women who died of cervical cancer were born in British Columbia (20). Thirteen women were born in other Canadian provinces and 3 were born in the United Kingdom.

Table 9
Marital Status of Women Who Died of
Ovarian, Uterine and Cervical Cancer
British Columbia, 1996

• Of the 183 women who died of ovarian cancer, over half were married. Fifty eight women were widowed and 15 were divorced.

• For women who died of uterine cancer, 27 were married and exactly the same number were widowed.

• In 1996, 23 women who died of cervical cancer were married and 10 were widowed.

Table 10
Deaths by Age Group and Community of Residence for Ovarian Cancer
British Columbia, 1996

• In 1996, Vancouver had the highest number of deaths from ovarian cancer (24). Twelve of these women were in their 70s and 7 were in their 60s. The second highest number of deaths were seen in Victoria with 7 women being in their 70s and 5 in their 80s.

• In 1996, one woman in her 20's died of ovarian cancer (a resident of Port Coquitlam). Two women in their 30s died of ovarian cancer and they were residents of Nanaimo and Vancouver. Twelve women died of ovarian cancer in their 40s.

Table 11
Deaths by Age Group and Community of Residence for Uterine Cancer
British Columbia, 1996

• In 1996, Burnaby was the place of residence for the highest number of deaths (13) from uterine cancer, nine of which died at age 70 or greater. Abbotsford closely followed with 12 deaths, all age 70 or more, with four deaths for each age group of 70-79, 80-89 and 90 and over.

• Two women in their 40s were the youngest to die of uterine cancer and they were residents of Burnaby and Kelowna.

Table 12
Deaths by Age Group and Community of Residence for Cervical Cancer
British Columbia, 1996

• The highest number of deaths for cervical cancer was for women who were residents of Langley. Of these six deaths, three were in their 70s, two were in their 60s and one was in her 40s. Two other areas had 4 deaths and these were Campbell River and Kamloops.

• Two women in their 30s were the youngest to die of cervical cancer and they were residents of Campbell River and Merritt.

Table 13
Occupations of Women Who Died from
Ovarian, Uterine and Cervical Cancer
British Columbia, 1996

• In total, over 85 percent of all death records for the reproductive cancers in 1996 indicated the occupation of the deceased.

• For ovarian cancer deaths, over 42 percent (75 women) of the women who died in 1996 were homemakers and about 18 percent (32 women) had clerical or cashier positions.

• Over 44 percent (28 women) of all women who died of uterine cancer were homemakers and over 20 percent (13 women) had clerical or cashier positions.

• Over 41 percent (16 women) of all women who died of cervical cancer were homemakers and 23 percent (9 women) were in clerical or cashier jobs.

More on Cervical Cancer

In 1949, British Columbia was the first province to establish a provincial screening program (pap tests) for the detection of cervical abnormalities.⁷ Although the screening program has been responsible for the overall decrease in incidence and mortality rates, cervical cancer deaths (particularly among younger age groups) still remain. In fact, the proportion of women under age 50 dying of cervical cancer is greater than for lung cancer or breast cancer. Women under the age of 50 represented 33% of cervix cancer deaths from 1990 to 1996 compared to 12.8% for breast cancer and 5.8% for lung cancer. The reason behind this could be lack of screening on a regular basis. This could be due to lack of education and information or other obstacles such as childcare responsibilities, employment or transportation issues.

A study in Manitoba found that single, older women who lived in rural or northern parts of the province were not likely to receive pap tests. Other studies in Canada have identified that socioeconomic conditions of women determines their screening. Women with more education and higher incomes tend to have more pap tests than those who are recent immigrants, have less education, and those who are rural residents.⁶ In order for a screening program to achieve optimal results, the characteristics of each community in terms of its population, immigration history and educational levels, must be considered. Groups at the community level need to be involved in designing programs to educate and inform women of the advantages of the screening programs.

References

1. American Cancer Society, Cancer of the Uterus, 1995

2. American Cancer Society, Ovarian Cancer, 1995

3. BC Cancer Agency. Annual Reports, 1974-1995

4. Buhle, E, L., High levels of Saturated Fat and Ovarian Cancer University of Pennsylvania, 1994

5. Christensen, D., Women Smokers carry cancer-causing chemicals in cervix, New York Times, 1996

6. Goel, Vivek. Factors Associated with Cervical Cancer Screening: Results from the Ontario Health Survey,
   Canadian Journal of Public Health, March 1994

7. Karsai, et al., Cervical intraepithelial neoplasia in female prisoners in British Columbia,
   Canadian Medical Association Journal, 139, October 15, 1988

8. Katz, S. and Hofer, T., Socioeconomic Disparities in Preventive care persist Despite universal
   Coverage, JAMA, 272(7), August 1994

9. King, H.S. et al., Uterine cancers in Alberta: trends of incidence and mortality,
   Canadian Medical Association Journal, Vol.127, October 1982

10. Miller, A.B. et al. Report of a National Workshop on Screening for Cancer of the Cervix,
    Canadian Medical Association Journal, 145(10), November 1991

11. National Cancer Institute, Cervical Cancer, (http:\\www.noah.cuny.edu/cancer/nci/cancernet/200103.html)

12. National Cancer Institute, NIH Consensus Conference Statement on Ovarian Cancer, Cancer WEB
    (http://www.graylab.ac.uk:80/cancernet/400041.html)

13. National Cancer Institute, Ovarian Epithelial Cancer

14. Rich, William., Ovarian Cancer, Internet (http://dialspace.dial.pipex.com:80)

15. Risch, H. et al., Parity, Contraception, Infertility and the Risk of Epithelial Ovarian Cancer,
    American journal of Epidemiology, 140:585-97, 1994

16. Snider, J et al., Trends in Mammography and Pap Smear Utilization in Canada,
    Chronic Diseases in Canada 17(3/4), 1996

Glossary

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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. In this report, ASMRs for females were standardized using Canada Census female population. Rates prepared by the British Columbia Vital Statistics Agency and those obtained from BC Cancer Agency reports were derived using 1971 Canada Census as a standard. Provincial/national ASMR comparisons from Statistics Canada publications utilized 1991 Canada Census population.

Alcohol-Related:
This category includes all deaths stated as being directly or indirectly related to alcohol. It should be noted that where alcohol is an indirect cause of death (i.e. not primary) 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-9 codes - 291, 303, 305.0, 357.5, 425.5, 535.3, 571.0-571.3, 571.5, 577.1, 648.4, 760.7, E860, 790.3.

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. Standard Geographical Code (SGC), derived from 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, homicide, legal intervention, misadventures and injury from war operations. Standard 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 E810-E825, E929.0), poisoning (E850-869, E929.2), falls (E880-E888, E929.3), burns/fire (E890-899, E924, E929.4), drowning (E830, E832, E910), other accidents - all codes from E800-E949 not already noted. Suicide ICD-9 codes are E950-E959; homicide (E960-969); "other" consists of legal intervention (E970-978), undetermined if accidental or purposely inflicted (E980-989) and war operations (E990-999).

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

• rheumatic/valvular: 391-398, 424
• hypertension: 401-405
• ischemic: 410-414, 429.2
• conductive & dysrythmic: 426-427
• heart failure: 428
• congenital: 745-746
• other: pulmonary - 415-417, inflammatory - 420-423, 429.0, cardiomyopathy - 425, 429.3, degenerative - 429.1, other, ill-defined or unspecified - 429.4-429.9

ICD-9:
The ninth revision of International Classification of Diseases, World Health Organization, Geneva, 1977. An internationally used system of approximately 12,000 four 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.

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

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

Neoplasms (ICD-9 140-239):
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-9 breakdown used in "Neoplasm Deaths" tables are;

• lung: includes trachea, bronchus, lung (ICD-162) and pleura (163)
• female breast: (ICD-174)
• colorectal: includes colon (ICD-153) and rectum, rectosigmoid junction and anus (154) other G.I. (Gastrointestinal): includes esophagus (ICD-150), stomach (151), small intestine and duodenum (152), liver & intrahepatic bile ducts (155), gallbladder and extra-hepatic ducts (156), pancreas (157), peritoneum (158), other and ill-defined within digestive organs (159).
• female reproductive: includes uterus (ICD-179), cervix (180, 182), placenta (181), ovary and adnexa (183), vagina & external genitalia (184).
• male reproductive: includes prostate (ICD-185), testis (186), penis & other genitalia (187).
• blood lymph: includes lymphatic and haematopoietic tissue (200-208).
• 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), ill-defined or unspecified sites (140- 149, 160, 161, 164, 165, 170-173, 175, 188-189, 190-199).
• non-malignant & unspecified: includes benign (210-229), in-situ (230-234), and neoplasms of unspecified nature (e.g. "tumor" - 239).

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

• respiratory disease with four sub-categories of emphysema (ICD-492), chronic obstructive pulmonary disease (COPD) (496), pneumonia/influenza (480-487), and other respiratory diseases (ICD-460-478, 490-491, 493-495, 500-519).
• diabetes (250)
• alcohol related - see above.
• AIDS: includes AIDS and HIV infections (ICD-042-044).
• cerebro and other vascular: includes cerebrovascular disease (ICD-430-438), disease of arteries and veins (440-456), hypotension (458), and other circulatory system disease (459).
• liver disease: ICD-570-573.

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

[Other] Reproductive and Female Genital Cancer:
Cancers under this heading as referred to on page 19 of this issue, are, collectively, other than cancer of ovary, uterus, or cervix. This category includes cancers of placenta (ICD-9, 181), fallopian tube (183.2), broad ligament (183.3), parametrium (183.4), round ligament (183.8), other adnexa (183.9), and external female genitalia (184.0 - 184.8).

Stillbirth:
The complete expulsion or extraction from its mother after at least 20 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 consequential relationships of conditions and diseases from immediate cause backwards to underlying cause.

Editor's Note:

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Electronic availability of the "Quarterly". Standard tables provided in this issue will be added to the Ministry of Health's Health Planning Database (HPDB) soon after distribution. Also, look for this whole issue at our web site address, http://www.hlth.gov.bc.ca/vs/.

Quarterly Digest User Evaluation. A selected number of our readers received a survey form with this issue along with a postage paid, self-addressed envelope which provides an opportunity for many of our readers to let us know what they think of this publication and suggest ways to make it better. We appreciate and value your input. If anyone who did not receive a User Evaluation would like to participate, please contact the editor (see Readers' Notes) and one will be mailed/faxed to you. Where we have several readers at one site, please feel free to send copies.

Contributors' Note:

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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, Lotus 123, Power Point, Corel Draw, etc.). Article presentation will be subject to space allowances and publishing deadlines.

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