Quarterly Digest
Volume 7 - Number 4 May 1998

• Preface
  
  
• Map: B.C. Local Health Areas
  
  
• British Columbia: Local Health Areas (LHA) within Health Regions
  
  
• Vital Event 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:
  The Declining Trend of Sudden Infant Death Syndrome: Comparison with other major
  causes of infant mortality and infant deaths due to unkown causes, BC, 1985 to 1996.
  by R. Fisk, J. Macdonald, W. Vandeer Kuyl, with editorial comments by S. Peck
  
  
  • Glossary
    
    
  • British Columbia Vital Statistics Agency - Reports and Publications
    
    
  • Index of Quarterly Digest Articles to date
    
    
  • Editor's Note
    
    
  • Contributors' Note
    
    
  • Readers' Note
    
    
  
  

Preface

This publication marks the completion of seven years of "Quarterlies. " Standard tables of vital event statistical information in this Quarterly Digest provide 1997 fourth quarter and year-end data. These are the first complete 1997 birth, death, marriage, and stillbirth statistics to be provided in publication. Tables are provided in the usual format by Local Health Area (LHA) and twenty Health Regions.

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/.

Due to the fact that Vital Statistics Agency's files are continually being updated, totals compiled by addition of the annual quarters may 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 was written by Dr. Robert Fisk, Consultant Epidemiologist, Non-Communicable Disease Epidemiology, Public and Preventive Health Division and contains editorial comments from Dr. Shaun Peck, Deputy Provincial Health Officer. It examines the apparent decline of death due to Sudden Infant Death Syndrome (SIDS). The validity of this decline is substantiated by comparison to an overall decrease in infant mortality and to infant deaths from "unknown/undetermined" causes that might otherwise potentially have been SIDS. Comparison is also made to other selected causes of infant mortality. In addition, the trend in SIDS mortality is examined for both Aboriginal infants and "other BC infants" and notable differences are identified. Our thanks goes to the authors for their excellent contribution to this "Quarterly" and to increasing our understanding of recent changes in SIDS mortality.

Along with our previous issue, selected readers received an evaluation survey. Thank you to all who responded. Beginning with our next issue, the first for 1998, we will begin to implement as many of your suggestions as possible. We have included this same survey in the back of this issue to afford all of our readers an opportunity to let us know how we are doing and how we can improve. We value your input through this reader survey and at any time.

British Columbia
Local Health Areas

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

The Declining Trend of Sudden Infant Death Syndrome:

Introduction

During the last 16 years, the rate of SIDS in BC has been higher than the national average. However, over time the rate in BC has declined more than the national rate, such that the BC rate is now comparable to the Canadian average (see Figure 1)

The question has been raised as to whether there is a real decrease in SIDS, or whether the decrease can be explained by changing diagnostic practices, such as categorizing more infant deaths as being due to unknown causes, or even perhaps to some other specific causes identified for infant deaths previously categorized as SIDS.

These questions are relevant in view of the definition of SIDS, which is "the sudden and unexpected death of an apparently healthy infant less than one year of age, which remains unexplained even after a full investigation. "¹ All data described in this paper relate to infants, i.e. children aged less than 12 months.

¹Health Canada, Canadian Foundation for the Study of Infant Deaths, Canadian Institute of Child Health, and Canadian Pediatric Society, "Joint Statement: Reducing the Risk of SIDS in Canada", August 1993.

Sids and Unknown Cause Mortality

Toward the end of February of each calendar year, the British Columbia Vital Statistics Agency (BCVSA) compiles mortality statistics for the previous year, based on the information contained in the Registration and Medical Certification of Death, using the morbid entity categories of the International Classification of Diseases, Ninth Revision (ICD-9). For situations in which the final diagnosis is awaiting autopsy results and/or a coroner's investigation, that case is temporarily placed in the "unknown" category pending a final decision on cause of death. Infant deaths suspected as being due to SIDS or some other unexpected cause are often caught in a temporary holding pattern that is subject to frequent data updates of the BCVSA. In examining the recent pattern of mortality for SIDS and Unknown Causes, it is necessary to await the final decision on the cause of infant deaths in each year.

The cause of infant deaths in 1996 has now been assigned for all cases², and the data on SIDS and Unknown Causes for the latest available five years are shown below in Table A. In order to include all possible unknown, non-specific, or uncertain causes of death which could have been assigned to infant deaths, the ICD codes used in this analysis were 798.1 (instantaneous death), 798.2 (death occurring in less than 24 hours from onset of symptoms, not otherwise explained), 798.9 (unattended death), and 799 (other ill-defined and unknown causes of morbidity and mortality). The ICD code for SIDS is 798.0.

²While the two unknown deaths in 1996 are now considered "final", a more specific cause will still be assigned later if justified by new information.

Since both SIDS and Unknown Cause deaths have decreased during this time, it is clear that the decline in SIDS is not associated with an increase in the Unknown Cause category in recent years in the provincial population. Using BC data available from 1985, the longer term pattern of SIDS and Unknown Causes mortality was also examined (see Figure 2)

While SIDS has declined over that time, the Unknown Cause rate increased somewhat to 1992, then declined thereafter. If the SIDS and Unknown Cause categories are combined, on the presumption that the unknown cases should have been diagnosed as SIDS, this would only have had a minor effect on the declining SIDS trend (Figure 3).

Aboriginal SIDS and Unknown Cause Mortality

In 1996, Aboriginal infant live births numbered 3,102, which was 6.8% of the provincial total of 45,883 live births. In the same year, Aboriginal SIDS cases numbered 7, which was 29.2% of the provincial total of 24 SIDS cases. The actual number of cases by Aboriginal status is graphed above (See Figure 4). As the Aboriginal cases include Status Aboriginals, but exclude non-Status Aboriginal people, it is quite probable that these data portray an incomplete picture of the SIDS problem within Aboriginal people as a whole. (Note - unless otherwise stated, in this paper, the term "Aboriginal" refers to Status Indians, in accordance with the Federal Indian Act).

Nevertheless, the data indicate that of the 563 SIDS cases occurring in BC during 1987 to 1996, there were 144 SIDS cases amongst Aboriginal Status infants, which is 25.6% of the total cases. As shown in Figure 5, the proportion of SIDS cases in the province occurring to Aboriginal Status infants has been increasing over time, as the SIDS rate has declined in other BC residents.

Returning to the initial question of Unknown Causes and SIDS - for Aboriginal status infants, there is a very high rate of both SIDS and Unknown Cause mortality as compared with other BC residents. Even if some of the Unknown Cause deaths should have been diagnosed as SIDS, hence "undercounting" SIDS, that would have had little effect on the overall SIDS pattern in Aboriginal infants, which is still considerably higher than for other BC residents (See Figure 6). The Aboriginal SIDS pattern also demonstrates considerable annual variation due to small numbers.

Upon review of the 10-year trend in both SIDS and Unknown Causes, SIDS has been declining in both the Aboriginal Status and Other BC Residents populations, as noted in Figure 7, with the Aboriginal rates varying greatly due to small numbers. The Unknown Cause mortality for Aboriginal infants, though also more unstable due to small numbers, was comparable to the SIDS mortality for other BC residents, and hence cannot be considered to be insignificant.

A comparison of the cumulative mortality over 10 years is shown in Table B. These data indicate that infants with Aboriginal status had an increased risk of mortality due to SIDS which was approximately 5 times the risk for other BC residents, and had an increased risk of mortality due to Unknown Causes which was about 9 times the risk for other BC residents. As noted above in Figure 7, the Aboriginal Unknown Causes mortality was about the same rate as SIDS in other BC residents. For general comparison, the Relative Risk for Total Infant Mortality in Aboriginal infants was 2.1 times higher than for other BC Residents.

Other Causes of Infant Mortality

While the SIDS rate has declined in recent years, so has total infant mortality and infant mortality for causes other than SIDS (Figure 8). Thus the decline in SIDS, while not associated with an increase in Unknown Causes, has occurred within an overall pattern of declining infant deaths due to other causes, which will be examined further. As in Figures 1 and 5, trendlines will be shown to smooth the annual variation due to small numbers found in many of these graphs.

The major causes of infant mortality are shown in Figure 9. Cumulative mortality rates for the most recent three-year period (1994-96) were examined, in order to reduce the effect of annual volatility due to small numbers, while still remaining current. The proportions (%) for each cause of death are also stated, with SIDS being the 3rd most common major cause of death, after Certain Perinatal Conditions and Congenital Anomalies. (Note that from the perspective of preventing post-neonatal mortality from age 28 days to 12 months of life, SIDS takes on greater significance, as mortality due to Certain Perinatal Conditions has largely already occurred within the first month, and mortality due to Congenital Anomalies is less readily preventable at this stage because of the severity of medical problems associated with these conditions.)

On reviewing the mortality pattern further for other causes of infant deaths, the ICD grouping of Certain Perinatal Conditions was examined. The causes of this group of conditions originate within the perinatal period, that period of time just before, during, and after birth. The great majority of these deaths occur during the first six days of life (85%), with most of the remainder (13%) occurring within the next 7 to 27 days of life³. Thus, while the condition originates in the perinatal period, the death may sometimes occur after the perinatal period, but will still be coded in the ICD system as a perinatal condition. As evident in Figure 10, mortality due to Certain Perinatal Conditions has declined slightly over the last 12 years.

³BC Vital Statistics Agency, Annual Report 1996.

The Congenital Anomalies mortality trend is shown in Figure 11. It has also declined over the last 12 years, although not quite as much as SIDS.

Mortality due to all Other Natural Causes was examined in Figure 12, which showed a fairly flat trend with a very slight decline over the last 12 years. This grouping was chosen because it encompasses a very wide range of different diseases, which are such rare causes of infant mortality, that separate analysis is unlikely to be informative.

Mortality due to External Causes (a category which includes unintentional injury, poisoning, violence, etc.) was examined in Figure 13. These are very rare causes of infant death and the trend was fairly flat, with minor variation over the last 12 years.

Summary and Conclusions

Over the last 12 years, the decline in SIDS has been accompanied by a decline in some other major causes of infant death (Certain Perinatal Conditions, Congenital Anomalies, and to a lesser extent, Other Natural Causes), with a relatively stable and low rate of mortality due to External Causes and Unknown Causes. There is no indication that the declining SIDS rate is associated with an increase in death due to Unknown Causes, or due to an increase in any other major cause of infant death, which suggests that the decrease in SIDS is a real phenomenon.

However, for Aboriginal infants, the diagnosis of Unknown Causes was used proportionately more often (9 times) than for other BC residents. Therefore, the high SIDS mortality in Aboriginal infants was positively associated with a high mortality due to Unknown Causes, and the lower SIDS mortality in other BC residents was positively associated with a lower mortality due to Unknown Causes. This finding is the opposite of initial concerns of a possible negative association. As Aboriginal infants have a much greater mortality rate due to Unknown Causes, it is recommended that the mortality review process examine such cases to determine reasons for the discrepancy. Contributing factors could potentially include geographic isolation, access to autopsy services, cultural issues, investigative problems, or perhaps other factors.

The major finding was that Aboriginal infants experience a rate of SIDS, which while decreasing over time, has been much higher (almost 5 times) than for other BC residents from 1987 to 1996. It was further evident that as SIDS among other BC residents has declined, the proportion of the BC total SIDS cases occurring to Aboriginal infants has increased.

Editorial Comments

Sudden Infant Death Syndrome (SIDS) has been of particular concern to BC's Children's Commissioner. In the five year period from 1992 - 1996, there has been a 56 percent reduction of SIDS deaths (from 55 to 24). This paper demonstrates that this is a real reduction and not a result of any classification of death issue, such as an increase in "Unknown Cause". The "Unknown Cause" classification has also fallen from 14 to 2 (an 86 percent reduction in the same period).

The continued high proportion of SIDS deaths in Aboriginal infants (29.2 percent of SIDS deaths in 1996 were Aboriginal infants even though Aboriginal live births account for only 6.8 percent of the provincial births) is of special concern. The proportion of SIDS cases occurring in the province to Aboriginals has increased over time, and so has the number of Aboriginal infant deaths classified as "Unknown". Over a ten year period, infants of Aboriginal status had an increased risk of mortality due to SIDS which was approximately five times the risk for other BC residents. Aboriginal infants had an increased risk of mortality due to "Unknown Causes" which was nine times the risk for other BC residents.

Over the last three years SIDS has accounted for 13.5 percent of all causes of infant mortality. The overall drop in the number of SIDS deaths that has occurred is encouraging. The evidence is that breast feeding, avoidance of smoking during pregnancy, elimination of exposure to environmental tobacco smoke, temperature control, and sleeping on the back all can contribute to the prevention of SIDS.

The continued high rate of SIDS in Aboriginal infants warrants increased attention. Factors that might be contributing to this are the education level and postnatal support for the mother and family, and poverty. These need further action to ensure that knowledge already obtained by research is actually applied to BC's Aboriginal families. This action should include ensuring that services and resources are available to Aboriginal families both on and off reserves to meet their needs.

There has been a continuous constitutional debate regarding who has jurisdiction or fiscal responsibility for social programs and services for Aboriginals; and if service delivery is on reserve, who has jurisdiction or fiscal responsibility. The recent "Report of the Task Force on Safeguards for Children and Youth in Foster or Group Home Care" addresses this issue [Recommendation #32]. In addition, the Children's Commissioner's recent report supported that recommendation.

Investigation of "Unknown Causes" in Aboriginal infants warrants further analysis of contributing factors such as geographic isolation, access to autopsy services, cultural and investigative factors.

BC's total infant mortality rate for 1996 was 5.0 per 1,000 live births. For BC Aboriginal infants it was 10.3, while for all non-Aboriginal BC infants it was 4.6 per 1,000 live births. This means that for non-Aboriginal infants, BC is achieving a level close to the best in the world. Other countries such as Sweden, Japan, and Finland are achieving infant mortality rates of 4.0 per 1,000 live births. The investigation of the preventable causes and implementation of effective preventive measures for infant deaths, particularly from SIDS and "unknown causes" in Aboriginal infants, should be a priority for British Columbia.

Sources

Robert Fisk, M.D., Consultant Epidemiologist, Non-Communicable Disease Epidemiology, Public and Preventive Health Division, BC Ministry of Health; Julie Macdonald, Medical Advisor, Information and Resource Management, BC Vital Statistics Agency; Wendy Vander Kuyl, Research Assistant/Secretary, Non-Communicable Disease Epidemiology, Public and Preventive Health Division, BC Ministry of Health.

Glossary

[Return to Table of Contents]

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 include 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.

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.

British Columbia Vital Statistics Agency Reports and Publications

The Vital Statistics Agency continues to be actively involved in the preparation of various reports and publications which present and measure British Columbia's vital event data. These studies, reports, texts, and periodicals are intended as research tools to assist health planners, researchers, and health care administrators. Except where otherwise indicated, the following publications are available upon request from the Agency (see "Readers' Note" for distribution contact).

British Columbia Vital Statistics Agency, Ministry of Health, Victoria, British Columbia. For the Ministry of Health for Medical Services Branch of Health Canada (December, 1997). Analysis of Status Indians in British Columbia: Updated Report, 1991 - 1996. Victoria, British Columbia.

British Columbia Vital Statistics Agency, Ministry of Health, (1991-1998). Quarterly Digest. Vol.1 (1&2) to Vol.7 (4). Victoria, British Columbia.

Burd Martha (1994). Regional Analysis of British Columbia's Status Indian Population: Birth-Related and Mortality Statistics. Division of Vital Statistics, Ministry of Health. Victoria, British Columbia.

Burr K.F., McKee B., Foster L.T., Nault F., "Interprovincial Data Requirements for Local Health Indicators: The British Columbia Experience" in Health Reports, 1995, Volume 7 No. 2, Statistics Canada, Ottawa, Ontario.

Division of Vital Statistics, Ministry of Health. Health Status Indicators in British Columbia, Birth-Related and Mortality Statistics, 1991-1995. Volume 1: Local Health Areas (Dec.,1996); Volume II: Health Units (Dec., 1996); Volume III: Communities (Mar., 1997). Victoria, British Columbia.

Division of Vital Statistics, Ministry of Health, (May,1996). Health Status Registry: Congenital Anomalies - Genetic Defects - Selected Disabilities, British Columbia to 1994. Victoria, British Columbia.

Division of Vital Statistics, Ministry of Health, (Oct., 1995). Mortality and Health Status in Vancouver: An Analysis by Neighbourhood Areas. Victoria, British Columbia.

British Columbia Vital Statistics Agency, Ministry of Health, (1992). Physicians' and Coroners' Handbook on Medical Certification of Death. Victoria, British Columbia. (1998 Revision - soon available).

Division of Vital Statistics, Ministry of Health, (1997). Selected Vital Statistics and Health Status Indicators: One Hundred Twenty-Fifth Annual Report 1996.

Division of Vital Statistics, Ministry of Health, (1994). The Nineteen Eighties. A Statistical Resource for a Decade [and century] of Vital Events in British Columbia. Victoria, British Columbia.

Foster L.T. & McKee B. (June, 1994). Inter-Jurisdictional Data Exchange: Its Importance in the Use of Vital Statistics Data for Decision Support Analyses in Management Information Systems. Division of Vital Statistics, Ministry of Health, Victoria, British Columbia.

Foster L.T., Burr K.F., Mohamed J. (1994). Screening for Health Area Benchmarks in British Columbia: The Use of Vital Statistics Data. Division of Vital Statistics, Ministry of Health, Victoria, British Columbia.

Foster L.T., & Edgell M.C.R., (Eds) (1992). The Geography of Death: Mortality Atlas of British Columbia, 1985-1989. Western Geographical Series, Vol. 27. Victoria, British Columbia: University of Victoria. Available through the Dept. of Geography, University of Victoria, P.O. Box 3050, Victoria, BC, V8W 3P5. Fax. (250) 721-6216, for $50.00 plus G.S.T. and $1.50 for shipping.

Foster L.T., Macdonald J.M., Tuk T.A., Uh S.H., Talbot D. (1995). "Native Health in British Columbia: A Vital Statistics Perspective; Chapter 2" in A Persistent Spirit: Towards Understanding Aboriginal Health in British Columbia. Canadian Western Geographical Series 31, University of Victoria, Victoria, British Columbia. Available through the Dept. of Geography, University of Victoria, PO Box 3050, Victoria, BC, V8W 3P5.

Foster L.T., Uh S.H., Collison M.A. (1992). Death in Paradise: Considerations and Caveats in Mapping Mortality in British Columbia (1985-1989). Victoria, British Columbia, Division of Vital Statistics. Also in M.V. Hayes, L.T. Foster, H.D. Foster, (Eds.), Community, Environment and Health: Geographic Perspectives. Western Geographical Series, Vol.27. (pp. 1-37). Victoria, British Columbia, University of Victoria.

Kierans W.J., Collison M.A., Foster L.T., Uh S.H., (1993). Charting Birth Outcome in British Columbia: Determinants of Optimal Health and Ultimate Risk. Victoria, British Columbia, Division of Vital Statistics.

Macdonald J.M., Tuk T.A., Cranfield C. (1993). Cancer Mortality in British Columbia: 1988-1992, Patterns of Underlying Cause and Multiple Cause Data. Victoria, British Columbia, Division of Vital Statistics.

Macdonald J.M., Tuk T.A., Mohamed J.H., (1992). Cardiovascular Disease Death in British Columbia: Still Number One. Victoria, British Columbia, Division of Vital Statistics.

MacNab Ying C., Macdonald J., Tuk. T., (1997), "The Health Impact of Delayed Childbearing in British Columbia, 1987-1994" in Vol. 9, No. 2, Health Report Statistics Canada, Ottawa.

MacNab Ying C., (Feb., 1994). Mortality Mapping in British Columbia: A Bayesian Approach. Victoria, British Columbia, Division of Vital Statistics.

Strohmaier R.M., Hu W., (1992). A Deadly Affair: Smoking-attributable Deaths, British Columbia, 1985 and 1989. Victoria, British Columbia, Division of Vital Statistics.

Tuk T.A. & Macdonald J.M. (Jan., 1995). Drug-Related Deaths in British Columbia: 1981 to 1993. Division of Vital Statistics, Ministry of Health, Victoria, British Columbia.

Tuk T.A., Macdonald J.M., (1995) Suicide, Homicide, and Gun Deaths, British Columbia: 1985 to 1993. Division of Vital Statistics, Victoria, British Columbia.

In progress

Accident Fatality in British Columbia, 1987 - 1995, by E. Demaere.

Physicians' and Coroners' Handbook on Medical Certification of Death and Stillbirth, 1998 Revision.

Selected Vital Statistics and Health Status Indicators, One Hundred and Twenty-Fifth Vital Statistics Annual Report 1997.

Trends in Smoking Habits and Smoking Attributable Mortality.

British Columbia Mortality and Natality Atlas using data for 1987 to 1997 and incorporating BC resident data from Alberta. Expected distribution - March 1999.

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 B.C. 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 to1996 - 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.

Topics presently in progress

1. The impact in the future of our aging "Baby Boomer" population on disease specific mortality.
2. Infectious disease and mortality (1 to 3 parts)
- overview
- focus on some selected diseases such as: hepatitis, tuberculosis, meningitis.

Editor's Note:

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Corrections. In the previous publication (Vol. 7, No. 3), there was an error in the calculation of the percentage of total deaths in the quarter that was made selected summary causes as shown in the pie graphs following standard tables. These should be corrected as follows:
p.11, deaths from external causes should be 7.2% (not 6.6%).
p.13, neoplasm deaths should be 29.5% (not 22.8%).
p.15, heart disease deaths should be 24.2% (not 19.5%).
p. 17, respiratory disease deaths should be 8.5% (not 7.9%).
In the same issue, figure 7 on page 29 should be labeled figure 10.
In Table 10 (p.31), Penticton is mentioned twice but the total count is correct.

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.

Quarterly Digest User Evaluation. Thank you to those of our readers who took the time to send us their much appreciated input. We have included the evaluation form as the last page of this issue and invite any readers who did not previously have the opportunity, to give us their opinions and suggestions. We have reviewed and summarized survey response thus far and will be incorporating many of the requested changes/improvements into our next issue. [Click here to down load evaluation form]

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

Readers' Note:

Comments, suggestions, questions, or criticisms regarding this publication?