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B.C. Home » Ministry of Health » Vital Statistics Agency » Statistics and Reports » Quarterly Digest » Fourth Quarter of 1998

• Preface
  
  
• Map: B.C. Local Health Areas
  
  
• British Columbia: Local Health Areas (LHA) within Health Regions
  
  
• Vital Event Statistics - October 1, 1998 - December 31, 1998 and Year-End Totals
  (Population, Livebirth, Death, Marriage, Stillbirth, Infant Deaths)
  
  
• Selected Birth Statistics - October 1, 1998 - December 31, 1998 and Year-End Totals
  (Low Birthweight, Preterm, Teenage Mother, Elderly Gravida, Cesarean Section)
  
  
• External Causes of Death - October 1, 1998 - December 31, 1998 and Year-End Totals
  (Accidents - [Motor Vehicle Accidents, Poisoning, Falls, Burns/Fire, Drowning, Other], Suicide, Homicide, Other External Causes)
  
  
• Neoplasm Deaths - October 1, 1998 - December 31, 1998 and Year-End Totals
  (Lung, Female Breast, Colorectal, Other G.I., Female Reproductive, Prostate, Blood/Lymph, Other Malignancy, Nonmalignant and Unspecified)
  
  
• Heart Disease Deaths - October 1, 1998 - December 31, 1998 and Year-End Totals
  (Rheumatic/Valvular, Hypertension, Ischemic, Conductive & Dysrhythmic, Heart Failure, Congenital, Other)
  
  
• Respiratory Disease Death Statistics - October 1, 1998 - December 31, 1998 and Year-End Totals
  (Emphysema, COPD, Pneumonia, Influenza, Asthma, Lung Disease from External Agents, Pulmonary Fibrosis, Other Respiratory)
  
  
• Other Selected Death Statistics - October 1, 1998 - December 31, 1998 and Year-End Totals
  (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:
  Hepatitis Deaths in British Columbia, 1990-1998
  by Z. Kashaninia

• 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 "Quarterly's" standard tables are for the fourth quarter and year-end 1998 and provide the first complete 1998 vital statistics in publication. As initiated for the first quarter, these are provided for the new "small" Local Health Areas and with additional cause of death categories (requested by our readers) introduced with 1998 data.

Due to the fact that Vital Statistics Agency files are continually being updated, totals compiled by addition of the annual quarters will not correspond exactly to year-to-date and year-end figures. For the same reason, depending on the date the data are extracted, there will be differences in numbers presented in this year's Quarterly Digests and those soon to be reported in the Vital Statistics 1998 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.

As a follow-up to the previous issue's article on death due to infectious diseases, this "Quarterly" features a more in-depth review of the direct and indirect impact of hepatitis on mortality. For this report, original death records were examined to specifically identify hepatitis C from among "other specified viral hepatitis" and numbers are provided for hepatitis by type. However, to offset any differences in identifying and recording types of hepatitis from 1990 to 1998, analysis is primarily based on the entire hepatitis group. This article provides an overview of changes in hepatitis mortality since 1990, gender, age, and regional differences, as well as findings reporting certain common factors noted on hepatitis-related death records. In addition, info boxes throughout the article provide a brief synopsis about each of the types of viral hepatitis.

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

R.J. Danderfer	Soo-Hong Uh
Director	Manager
British Columbia	Information and Resource
Vital Statistics Agency	Management Branch
	Vital Statistics Agency

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British Columbia
Local Health Areas

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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 South Vancouver 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

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Hepatits Deaths in British Columbia, 1990-1998

by Z. Kashaninia

Introduction

Hepatitis is the Latin word for inflammation of the liver. In most cases, hepatitis is caused by a variety of viruses, some of which can lead to cirrhosis (scarring) of the liver and death. In 1996, the World Health Organization reported a major increase in hepatitis infections and considered hepatitis as a major health issue of the 1990s and beyond. In British Columbia, 921 individuals died from or with hepatitis infections from 1990 to 1998.

This report will provide an analysis of hepatitis mortality in British Columbia from 1990 to 1998. Throughout the report, there will be references made to "Direct deaths" which refers to all deaths that were caused directly from hepatitis and "Indirect deaths" which refers to all individuals who had hepatitis but died directly of something other than hepatitis. A regional and provincial 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) plus an inter-provincial and national comparison will be provided. Information boxes on the most prevalent types of hepatitis will also be presented.

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 and injury entities were coded to the International Classification of Diseases 9^th Revision (ICD-9).

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) to the expected number of deaths in that area that are based on provincial age-specific mortality rates. (SMRs are used for comparing each LHA's observed infectious disease mortality relative to the Province as a whole).

It is important to note that all Hepatitis C deaths were coded under Other Specified Viral Hepatitis (ICD codes 0704 and 0705). For the purpose of this project, all the direct and indirect deaths with these codes were examined to identify the number of Hepatitis C related deaths. Upon thorough examination, all but one death (resulting from Hepatitis G) in this group were described as a direct or indirect result of Hepatitis C. Therefore, the Other Specified Viral Hepatitis category will always be referred to as Hepatitis C.

Before Hepatitis C was fully recognized, it is possible that some of the Hepatitis C deaths were coded as Unspecified Viral Hepatitis (0706, 0709) as opposed to Other Specified Viral Hepatitis (0704, 0705) or not identified as viral at all (5733). Therefore, this study will contain an analysis of the whole hepatitis group to offset any changes in diagnostic and recording practices over the review period.

Note: Includes non BC residents.

• Between 1990 and 1998, a total of 472 individuals died directly from hepatitis (283 males and 189 females) in British Columbia. Except 1992, the number of direct hepatitis deaths for males far surpassed the number for females in every year.

• 1998 was the year with the highest number of deaths for both males and females at 46 and 38 respectively. Compared to 1990, almost twice as many males and three times as many females died directly of some type of hepatitis in 1998.

Note: Includes non BC residents.

• Between 1990 and 1998, a total of 449 individuals died of causes other than hepatitis but had at least one form of hepatitis at the time of their death (309 males and 140 females).

• 1990 presented the lowest number of indirect hepatitis deaths for both males and females at 14 and 6 respectively.

• As with direct, 1998 was also the year with the highest number of indirect hepatitis deaths for both males and females at 78 and 29 respectively. Compared to 1990, more than five times as many males and females died indirectly with hepatitis in 1998.

^*Note: Includes one Hepatitis G.

• Between 1990 and 1998, a total of 472 individuals died directly from hepatitis. The highest number of deaths were from Hepatitis B and Other Specified Viral Hepatitis (Hepatitis C) at 143 and 119 respectively. 1998 was the year with the highest number of direct hepatitis deaths from all types of hepatitis except Unspecified Viral Hepatitis and Hepatitis Unspecified.

• By 1997, Hepatitis C replaced Hepatitis B as the leading type of fatal hepatitis.

• The most dramatic increase in the number of direct hepatitis deaths was from Hepatitis C (from no deaths in 1990 and 1994 to 45 deaths in 1998). The increase in 1995 corresponds to a decrease in Unspecified Vital Hepatitis perhaps reflecting changes in medical recording practices - as noted earlier. However, this respective increase and decrease are not offsetting.

• A total of 449 individuals died indirectly from hepatitis between 1990 and 1998. These individuals had 514 hepatitis conditions.

• As with direct hepatitis deaths, 1998 presented the highest number of indirect hepatitis deaths with Hepatitis C being responsible for the majority of these deaths (71 out of 107).

Note: Rate per 10,000 age and gender specific population.

• For males, the rate of death due to hepatitis increased with age beginning at 15, peaking in the 75-79 age group and declining slightly for those over 79.

• Due to the small number of deaths in some age groups (e.g. one death <age 1), the mortality rate patterns for females is not stable. However, in general terms, likelihood of death from hepatitis increased sharply after age 64.

• Males had a higher direct age specific death rate than females in all age groups except those less than one year of age and those in the 80-84 and 85 and over age groups.

• The highest direct age specific death rate for males was 6.48 in the 75-79 age group. For females, the highest rate was 5.84 for those aged 80-84.

Note: Rate per 10,000 age and gender specific population.

• The Age Specific rates for indirect hepatitis deaths for females increased sharply after age 15. The pattern would be similar for males except for relatively high rates in the 40 to 54 age groups. This may be related to a likelihood of immune compromised men with a history of drug abuse, alcohol and AIDS.

• In all age groups except for those 80-84, males had a higher indirect age specific death rate.

• The highest indirect age specific death rate for males was 5.92 for those 75-79. For females, the highest rate was 5.53 for those in the 80-84 age group.

Note: Rate per 10,000 age and gender specific standard population.
(using 1991 Canada Census as standard)

• The Age Standardized Mortality Rates (ASMRs) for all direct and indirect hepatitis deaths for males increased from 1.89 in 1990 to 4.68 in 1998. The lowest ASMR for males occurred in 1992 (1.73) while the highest appeared in 1998 (4.68).

• As with males, the Age Standardized Mortality Rates (ASMRs) for females increased (0.87 in 1990 to 2.27 in 1998).

• The total ASMR rates for all hepatitis deaths increased substantially (2.5 times) from 1.40 in 1990 to 3.46 in 1998. This increase occurred almost equally for both males and females.

Note: *SMR - standardized mortality ratio (Observed/Expected). (see glossary)
Cells that are shaded GREEN indicate a statistically significantly high difference between the observed and expected deaths and cells that are shaded GREY indicate a statistically significantly low difference between the observed and expected deaths (p<0.05, two tailed).
Excludes non BC residents.
When looking at the number of deaths in specific regions, readers should note that the observed number of deaths represents individuals who could have had more than one type of hepatitis. For example, Arrow Lakes represents 1 death from each type of Hep A, Hep B, and Hep Unspecified as well as 4 deaths from Hep C. However, the total number of individuals who died of hepatitis in that area is shown as 5. This explains that in total 5 individuals died of hepatitis but had 7 types of hepatitis at the time of their deaths.

• Based on Standardized Mortality Ratios (SMRs), seven Local Health Areas (LHAs) showed statistically significantly more hepatitis deaths (direct and indirect) than were expected. These were: Arrow Lakes (3.48), Vancouver Downtown East Side (3.38), Vancouver City Centre (2.38), Vancouver North East (1.77), New Westminster (1.71), Vancouver Midtown (1.69) and Vancouver South (1.62).

• The areas that showed statistically significantly fewer deaths than were expected were: Peace River South (0.18), Salmon Arm (0.23), Qualicum (0.42) and Abbotsford (0.52).

Alcohol, Drug Abuse and Hepatitis

Many studies have shown a close relationship between alcohol, drug abuse and hepatitis. In general, alcoholism impairs the immune system and factors such as malnutrition and liver disease can contribute to the individual's susceptibility to develop hepatitis (Rosman A, et al, Bronx Medical Centre, Bronx, NY). Drug abuse (particularly intravenous drug abuse, where needles are shared) is responsible for transmission of many types of hepatitis, particularly Hepatitis B and C. Between 1990 and 1998, over 45 percent of all hepatitis deaths in British Columbia showed a history of alcohol and/or drug abuse.

• Between 1990 and 1998, 43.4 percent of hepatitis related death records showed a history of alcohol abuse. Drug abuse accounted for 2.8 percent and the combination of alcohol and drug abuse was at 2.1 percent.

• Organ transplant complications and blood transfusions that resulted in a direct or indirect death from hepatitis accounted for 1.7 and 0.2 percent respectively. It should be noted that hepatitis deaths with blood transfusions reported were as a result of transfusions that occurred in the 1960s and early 1970s. Since it takes several years before deaths occur after a blood transfusion, it is likely that the number of deaths from transfusions will be higher in the years to come.

• The highest alcohol abuse for both males and females were for Hepatitis C related deaths at 57.1 and 54.1 percent respectively.

• Over 47 percent of all male Hepatitis A related deaths involved alcohol abuse. For females, the figure was at 12.5 percent.

• Forty seven percent of all male and 26.7 percent of all female Unspecified Viral Hepatitis related deaths involved alcohol abuse.

• Hepatitis B related deaths that showed a history of alcohol abuse were at 35.8 and 38.0 percent for males and females respectively.

• Chronic Hepatitis related deaths involving alcohol abuse were at 30.7 percent for males and 32.4 percent for females while Unspecified Hepatitis related deaths involving alcohol abuse were at 32.1 and 29.3 for males and females respectively.

• Twenty four percent of all male Unspecified Viral Hepatitis related deaths involved drug or a combination of drug and alcohol abuse compared to 10 percent for females.

• Of all male Hepatitis A related deaths, 23.5 percent involved drug or a combination of drug and alcohol abuse. None of the female Hepatitis A related death records showed a history of drug abuse.

• Twenty two percent of all male Hepatitis C related deaths involved drug or a combination of drug and alcohol abuse compared to 14.1 percent of females.

Note: Rate per 100,000 population. (using 1991 Canada Census population)
Source: Statistics Canada.

• In 1997, BC had the highest death rate per 100,000 population (1.5 times the national average) from viral hepatitis compared to the other provinces. British Columbia's rate was 3 times higher than Newfoundland, Manitoba and Saskatchewan.

• Ontario had the second highest death rate (0.9) after British Columbia.

Summary and Conclusion

Today hepatitis has become a major health issue worldwide. Viral hepatitis (particularly Hepatitis B and C) incidence and mortality are on the rise in many parts of the world including Canada. In 1997, over half of all Hepatitis C incidences in Canada were reported in British Columbia. Between 1990 and 1998, over 900 individuals died of all direct and indirect hepatitis related deaths in British Columbia, 191 of which occurred in 1998. Almost half (47 percent) of all deaths from hepatitis (particularly Hepatitis C) were reported with alcohol, drug abuse or in combination. Those who died of hepatitis were typically males in their 70s with a history of alcohol and/or drug abuse. The probability of dying from hepatitis increased rapidly for both males and females after they reached 40 years and continued to increase well into their 60s and 70s. Many types of hepatitis can take up to 20 years or more to result in fatality and therefore a sharp increase in the number of deaths from hepatitis, (particularly Hepatitis C) can be expected in British Columbia in the near future.

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. 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-9 E810-E825, E929.0), poisoning (E850-E869, E929.2), falls (E880-E888, E929.3), burns/fire (E890-E899, 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-E969); "other" consists of legal intervention (E970-E978), undetermined if accidental or purposely inflicted (E980-E989) and war operations (E990-E999).

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 (162) and pleura (163).
  
• female breast: (174).
  
• colorectal: includes colon (153) and rectum, rectosigmoid junction and anus (154).
  
• other G.I. (Gastrointestinal): includes esophagus (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 (179), cervix (180, 182), placenta (181), ovary and adnexa (183), vagina & external genitalia (184).
• prostate (185).
  
• 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, 186-199).
  
• 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:

• diabetes (250).
  
• alcohol related - see above.
  
• AIDS: includes AIDS and HIV infections (042-044).
  
• other infectious diseases (0010 to 0419, 0450-1398).
  
• cerebro and other vascular: includes cerebrovascular disease (430-438), disease of arteries and veins (440-456),
  hypotension (458), and other circulatory system disease (459).
  
• liver disease: (570-573).
  
• ALS/MS: amyotrophic lateral sclerosis and multiple sclerosis (3352 & 340).
  
• Alzheimer's disease (3310).
  
• Parkinson's disease (3320).
  

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 (492).
  
• COPD - chronic obstructive pulmonary disease (496).
  
• pneumonia (480-486).
  
• influenza (4870-4879).
  
• asthma (4930-4939).
  
• lung disease due to external agents, e.g. aspiration pneumonia, asbestosis, silicosis (500-5089).
  
• pulmonary fibrosis (515).
  
• other respiratory diseases (460-4789, 490-4919, 494-4959, 5100-514, 5160-5199).
  

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

Stillbirth:
The complete expulsion or extraction from its mother after at least 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.

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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, 1998). Analysis of Status Indians in British Columbia: 1991 - 1997. Victoria, British Columbia.

British Columbia Vital Statistics Agency, Ministry of Health, (1991-1998). Quarterly Digest. Vol.1 (1&2) to Vol.8 (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, (1999). Physicians' and Coroners' Handbook 1998 Revision on Medical Certification of Death. Victoria, British Columbia.

Division of Vital Statistics, Ministry of Health, (1998). Selected Vital Statistics and Health Status Indicators: One Hundred Twenty-Sixth Annual Report 1997.

British Columbia Vital Statistics Agency (1999). Selected Vital Statistics and Health Status Indicators: One Hundred Twenty Seventh Annual Report 1998.

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.

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 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.

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 Z. Kashaninia.

Topics in progress/planned

1. Drowning Fatalities in BC, 1990 to 1998.
   
2. Illicit Drug Deaths - update 1993 to 1998.

Editor's Note:

Infrequently, due to insufficient or incomplete address information (e.g. "no fixed address"), a vital event which is known to involve a resident of Vancouver can not be assigned to an appropriate Vancouver sub-area. In this issue for the last quarter of 1998, "unknown Vancouver" Area has been added to the LHAs listed in standard tables to count these events. This means that 17 deaths in the first three quarters of 1998 were assigned to either LHA 162 - Downtown East Side Vancouver or to 164 - Vancouver West Side that are now being counted as "Vancouver Unknown" in the year-end figures.

Contributors' Note:

The editorial staff would like to invite any readers who wish to contribute an article or paper summary for publication in this Quarterly Digest to contact the Information and Resource Management Branch of the British Columbia Vital Statistics Agency. Articles should focus on health status issues in British Columbia. It is preferable that submissions be in "electronic media" format (e.g. Word, Word Perfect, Excel, Power Point, Corel, Pagemaker, etc.). Article presentation will be subject to space allowances and publishing deadlines.

Readers' Note:

Re: "Letters to the Editor", or mailing and distribution.

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