Quarterly Digest
Volume 9 - Number 4 June 2000

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

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

• Vital Event Statistics - October 1, 1999 - December 31, 1999 and Year-End Totals
  (Population, Livebirth, Death, Marriage, Stillbirth, Infant Deaths)

• Selected Birth Statistics - October 1, 1999 - December 31, 1999 and Year-End Totals
  (Low Birthweight, Preterm, Teenage Mother, Elderly Gravida, Cesarean Section)

• External Causes of Death - October 1, 1999 - December 31, 1999 and Year-End Totals
  (Accidents - [Motor Vehicle Accidents, Poisoning, Falls, Burns/Fire, Drowning, Other], Suicide, Homicide, Other External Causes)

• Neoplasm Deaths - October 1, 1999 - December 31, 1999 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, 1999 - December 31, 1999 and Year-End Totals
  (Rheumatic/Valvular, Hypertension, Ischemic, Conductive & Dysrhythmic, Heart Failure, Congenital, Other)

• Respiratory Disease Death Statistics - October 1, 1999 - December 31, 1999 and Year-End Totals
  (Emphysema, COPD, Pneumonia, Influenza, Asthma, Lung Disease from External Agents, Pulmonary Fibrosis, Other Respiratory)

• Other Selected Death Statistics - October 1, 1999 - December 31, 1999 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:
  Beautiful and Deadly British Columbia: Natural Environmental Deaths, 1985 to 1998
  by T. Stubbings and J. Macdonald

• Glossary

• British Columbia Vital Statistics Agency - Reports and Publications

• Index of Quarterly Digest Articles to date

• Editor's Note

• Contributors' Note

• Readers' Note

Preface

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 may be differences in numbers presented in this Quarterly Digest and those soon to be reported in the 1999 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 well as being Beautiful, British Columbia can also present visitors and residents with harsh or unexpected elements of Nature that can prove fatal. This issue's feature article takes a look at 319 deaths that occurred between 1985 and 1998 that were caused by such "forces of nature" as avalanches, lightning strikes, landslides, wild animal attacks and exposure to storms or heat or cold. This report provides a descriptive review of these "natural environmental deaths" by examining characteristics such as age, gender, seasonal variation and event location. There is extra focus on the 111 deaths caused by avalanches/slides and the additional 165 deaths due to hypothermia/exposure - in terms of where the victims came from and where they died, and, in the case of hypothermia/exposure, the proportion Aboriginal and the involvement of alcohol. Findings, some of them unexpected, may suggest areas for prevention or intervention.

equests for changes, suggestions for article topics or contributions continue to be welcome. Your support and input into this publication has encouraged continuation through the 1990s and will continue to be greatly appreciated into the new century.

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

[Return to Table of Contents]

British Columbia
Local Health Areas

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

Beautiful and Deadly British Columbia:
Natural Environmental Deaths, 1985 to 1998

Introduction

On average, 23 people are killed each year in British Columbia due to natural occurrences such as avalanches, storms, and extreme temperature. The purpose of this study is to look at deaths between 1985 and 1998 that were caused by these "forces of nature". Some of these events, including avalanches, lightning strikes and wild animal attacks are sudden and violent, while others, such as exposure to cold temperatures and storms, can affect the victim over a longer period of time. Not included here, are "nature caused" deaths which involved a motor or water transport vehicle or deaths where the hypothermia was due to water submersion/drowning.

From 1985 to 1998, 319 people (including 80 non BC residents) died due to contact with BC's natural or climatic forces. Most notable were 111 deaths due to avalanches/mudslides and 111 due to non-drowning hypothermia. The following report provides a descriptive review of these 319 deaths by examining characteristics such as age, gender, seasonal variation and event location. Death from hypothermia is also examined for the involvement of alcohol and for the proportion involving Status Aboriginals.

Methodology

Data for this study were extracted from 1985 to 1998 deaths registered with the BC Vital Statistics Agency where the underlying cause of death (UCOD) had been given the following ICD-9 codes:

E9000, E9009		Exposure to excessive heat due to weather condiditions or of unspecified origin
E9010, E9108, E9109		Exposure to excessive cold(hypothermia) due to weather conditions or of other or unspecified origin
E9041, E9042		Lack of food and water
E9043		Exposure (not elsewhere classified)
E9050-E9056, E9059		Toxic reaction to venomous animals/insects
E9061-E9069		Other injury caused by animal (manual exclusion of domestic animals)
E907		Lightning
E908		Cataclysmic storms and floods
E909		Cataclysmic earth surface movements and eruptions
E892		Conflagration not in building or structure (e.g. forest, grass, prairie)

Once individual cases were identified, original death records were retrieved from microfilm and examined to confirm inclusion in the study and to provide a source for examination of such things as multiple victim events and place of occurrence. After this review, a database was created to provide analysis of the data for this report.

Measure of significant mortality for Health Region (HR) of residence is derived using standardized mortality ratios (SMR). Counts of deaths provided here include non BC residents. Non resident events are excluded in the calculations of age specific rates and ratios.

Status Aboriginal deaths were identified from the "status" flag for the Analysis of Status Indians in British Columbia project for Medical Services Branch, Health Canada. These data are the results of probabilistic record linkage among data from the BC Vital Statistics Agency, BC Medical Services Plan - Registration and Premium/Billing files and the Registered Indian Status Verification file (originating from the Indian Registry, Medical Services Branch, Health Canada).

• From 1985 to 1998, an average of 23 people died annually from contact with BC's natural forces.

• Over the 14 year period, with 111 deaths from each, hypothermia and avalanches/slides were the most lethal of natural elements. Combined, these categories accounted for almost 70% of natural environmental deaths.

• Deaths due to avalanches/slides and hypothermia occurred in every year from 1985 to 1998. The worst year for deaths from excessive cold was 1985. 1998 presented the most fatalities due to avalanches.

• In addition to deaths caused by avalanches and cold temperatures, 97 people died due to encounters with other natural elements. Most notable among these deaths were deaths from exposure/lack of food (55 deaths) and encounters with wild animals/bees or wasps (24 deaths).

• Exposure/starvation accounted for 17.2% of environmental deaths. Excessive cold and exposure/starvation considered together comprise the largest percentage of environmental deaths with 52.0%.

• While death from being struck by lightning is a rare occurrence, this happened 3 times from 1985 to 1998.

• From 1985 to 1998, BC's natural and climatic elements caused the deaths of 257 males and 62 females. Male deaths from these causes occurred 4 times more frequently than did female deaths.

• Male deaths exceeded female deaths in every year over the period.

• The male age group with the highest number of environmental deaths between 1985 and 1998 was the 30-34 age group, with 34 deaths. For females, the age group with the highest number was the 45-49 age group, with 7 deaths. Overall, the 30-34 age group had the most deaths with 38 total deaths.

• For age groups in which there was at least one environmental death, male deaths always exceeded female deaths, except for the 1-4 age group, where there was one male and one female death.

• While male deaths increased with age until they peaked in the 30-34 age group and then declined with age, female deaths did not seem to exhibit any noticeable pattern. Since male deaths were so much more prominent than female deaths, total deaths followed the same pattern across age groups as male deaths.

Note: SMR - standardized mortality ratio (Observed/Expected). (see glossary)
Cells that are shaded Blue 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.
C.I. = Confidence Interval - 95%.

• Among the 20 Health Regions, 6 Regions experienced statistically significantly more deaths from natural environmental causes than were expected if they followed the provincial pattern. Five Regions demonstrated a SMR value that was statistically significantly lower than expected.

• The Health Regions with statistically significantly high SMR values were, in descending order: 14-Peace Liard (5.11), 12- Cariboo (4.41), 2-West Kootenay-Boundary (3.72), 15-Northern Interior (3.41), 9-Coast Garibaldi (2.26), 5-Thompson (2.07).

• In addition to the Capital Region, other areas that were statistically significantly low for death due to natural environmental factors were located in the Lower Mainland. 7-South Fraser Valley had the statistically significantly lowest SMR value of 0.26 followed by 18- North Shore (0.34), 8-Simon Fraser (0.35), 20-Capital (0.39), and Vancouver (0.51).

Natural Environmental Deaths and the Involvement of Alcohol

Overall, there was a fairly high proportion of environmental deaths in which alcohol was a factor. Out of 319 total environmental deaths, there were 71 that were alcohol related. However, the number of alcohol related deaths were not evenly distributed among the causes of death included in this review. In fact, 68 of these 71 deaths involved individuals who died either from excessive cold or exposure to weather conditions. Of the remaining three deaths, one was due to excessive heat, while two were avalanche deaths.

Typically, the alcohol related deaths that were due to excessive cold or exposure were people who became extremely intoxicated and passed out in cold weather. Out of 111 total excessive cold deaths, 48 were alcohol related and out of a total 54 exposure deaths, 20 were alcohol related. In addition, two more deaths were related to a combination of drugs and alcohol. Over the time period, alcohol was a factor in 41.2% of deaths due to hypothermia or exposure. In 5 of the 14 years under review, this alcohol involved proportion was 50% or greater.

Among the 166 deaths due to hypothermia/exposure, there was a disproportionate number (46 or 27.7%) involving Status Aboriginals.

The percentage of Aboriginal deaths among the alcohol related deaths in these categories were even higher. Of the 48 excessive cold deaths that were alcohol related, 14 were Status Aboriginals, while of the 20 exposure deaths that were alcohol related, 13 were Status Aboriginals. This means that of all the hypothermia/exposure deaths that involved alcohol, approximately 40% of these deaths were Aboriginal people (27 of a total 68).

Natural Environmental Deaths - Place of Occurrence and Place of Residence

Note: LHA of residence and place of death in bold. See Table 5b for allocation of non resident deaths.

Prince George was by far the LHA with the highest number of environmental deaths in this study. Over the 1985 to 1998 period, there were 25 environmental deaths in Prince George, while the next highest LHA was Kootenay Lake/Nelson with 16 environmental deaths. Prince George also had the largest number of environmental deaths to residents with 20 of the 25 total environmental deaths. Again, this was a much larger number than the second highest LHA, Kootenay Lake/Nelson, which had 12 environmental deaths to residents. There were 10 LHAs that did not have any environmental deaths at all. These LHAs were: Creston, Southern Okanagan, Armstrong-Spallumcheen, Richmond, Maple Ridge, Sooke, Lake Cowichan, Ladysmith, Mission, and Central Coast. While there were no deaths in the above LHAs, there were 3 deaths to residents of Southern Okanagan, 1 death to residents of Richmond, and 1 death to residents of Mission (see Table 5 for breakdown of deaths by LHA of residence and LHA of death).

Overall, 18.2% of all deaths in this study were to non-BC residents (58 of 319). This is a relatively high proportion considering that the percentage of non-residents for all external causes of death between 1985 and 1998 was 5.1%. The overwhelming majority of these non-resident deaths were in avalanches, which accounted for 47 of the 58 non-resident deaths. This means that 48% of all avalanche deaths were to non-residents of BC (47 of 98). These high numbers are likely due to British Columbia's reputation as a high quality ski destination, attracting experienced skiers that want to challenge remote and dangerous terrain. (See Table 8 for location of avalanche fatalities). Most represented among the 58 non-resident deaths were other Canadians (25 of 58) - 20 from Alberta, 2 from the Yukon and 1 from each of Saskatchewan and Ontario. American fatalities numbered 17, the most (4 deaths) from California, Arizona, and Washington (3 deaths each). Fifteen fatalities involved individuals from Europe - 6 from Germany, 4 from England, 2 each from Switzerland and France, and one from Austria. There was also a death of a resident of Mexico.

Cold Weather and Exposure Causing Death

Along with the category for avalanches/mudslides, deaths due to excessive cold accounted for the highest number of environmental deaths (111 deaths). In many cases, deaths in the excessive cold and exposure categories were very similar, as death records in both categories often identify hypothermia as the immediate cause of death. However, deaths due to excessive cold and deaths due to exposure are distinct categories, as one necessarily implies cold weather conditions, while the other does not. The distinction is dependent on the implied intention of the certifier (coroner) as to whether or not the primary element to which the deceased was exposed was, or was not, excessive (sufficient to produce signs of hypothermia) cold. For this reason, in this report, the 165 deaths from these two causes are, for the most part, examined together.

Note: Rate per 100,000 population. Non residents are excluded.

• The male age group with the highest death rate from hypothermia/exposure between 1985 and 1998 was the 85+ age group with a death rate of 4.67. For females, the 80-84 age group had the highest rate, with 1.17.

• Overall, for the age groups in which there were hypothermia/exposure deaths, the male death rate (0.61) was almost 3.4 times larger than the female death rate (0.18). The male death rate was higher than the female death rate in all age groups except for the 15-19 age group, where there was 1 female death and no male deaths.

• Both male and female death rates generally increased with age. However, the female death rate declined after the age of 84.

• There were no hypothermia/exposure deaths to people under the age of 15, and only one death to people under the age of 20.

• The youngest person to die of exposure between 1985 and 1998 was 25 years old, while the oldest person to die was 95 years old.

Along with Avalanches and Mudslides, excessive cold was one of the categories with the highest variation from year to year. With as few as 3 deaths in 1989 and as many as 15 deaths in 1985, there is a possible correlation between these deaths and excessively cold winters. However, with many other variables that could contribute to the number of deaths in a given year, conclusions about cold winters are difficult to draw.

There were deaths from excessive cold in every month of the year except June. The months with the highest number of deaths were January and December, with 26 and 21 deaths respectively. In addition, there were 7 deaths between July and September. These deaths are possibly due to the fact that people were not prepared to deal with cold temperatures during the summer months.

Not included with the hypothermia/exposure group was one death due to starvation. While this case noted starvation as the underlying cause of death, hypothermia was noted elsewhere on the death record. This case involved a mental health patient who wandered from a hospital into a nearby park. Through the review process, several starvation deaths were excluded from the study, including deaths due to malnutrition or refusal to eat.

Avalanche/Landslide Fatalities

Many types of deaths can be classified under this group, as the ICD-9 code used for this group includes all deaths that result from earth movements. Accordingly, this category was tied for the highest number of deaths in this study with 111. The two most prominent destructive manifestations of these cataclysmic earth movements in BC are snow avalanches and landslides. There were only two deaths over the 1985-1998 period in which non-slide deaths had been classified in this category. One of these deaths occurred when a man fell 1000 meters when an overhang of snow collapsed. The second death occurred when the root of a tree came loose, causing the deceased to fall 150 feet to his death.

Snow avalanches can be extremely destructive, as they can uproot trees and displace large boulders due to the high velocities and massive amounts of snow. Single avalanches often kill numerous people. The worst snow avalanche in British Columbia's history occurred in 1910 when 62 workmen were killed at Roger's Pass. According to Natural Resources Canada, the workers were trying to remove snow from an earlier avalanche that covered the tracks of the Canadian Pacific Railroad.

Between 1985 and 1998, snow avalanches killed a total of 98 people in British Columbia. Seventeen avalanches over this time period killed two people or more, totalling 54 deaths of the 98. The remaining 44 victims were victims of separate avalanches. This makes a total of 61 snow avalanches that killed at least one person between 1985 and 1998. Almost all of these deaths were to individuals engaging in recreational activities such as hiking, skiing, or snowmobiling. However one death was to an elderly woman who was killed by an avalanche as it rolled down a mountain and through her home.

Landslides are massive movements of soil or rock that can be either rapid or slow. These types of slides killed far less people than snow avalanches, but were still significant with 11 deaths from 1985 to 1998. 1990 was the worst year for landslides in the study period, as landslides killed a total of 7 people. One of the slides in 1990 killed 3 members of a family, as the landslide tore through their home, trapping them inside. Another in the same year killed a father and his son as it swept through a rural farm. Most of the remaining landslide deaths were to individuals working outdoors in resource industries.

Deaths due to avalanches had some characteristics and trends that could be looked at in greater depth than many of the other causes of death. According to the National Snow and Ice Data Centre, avalanches are most common from December to April when most avalanches will "run" down a slope. Specifically, the highest numbers of deaths occur from January to March, when the snowfall levels are greatest in most mountain areas. Data from this study seem to support these statements (see Table 7). The three months with the highest number of avalanche deaths were from January to March. These three months accounted for 76.5% (75 of 98) of all avalanche deaths from 1985 to 1998.

However, March was clearly the most deadly month for avalanches in BC from 1985 to 1998 with 37 deaths. However, the numbers for March were somewhat deceptive, as they included six avalanches that killed at least two people, one of which killed 7 people, and another that killed 9 people. The same holds for January, as there were 5 avalanches that killed at least two people, and one of these killed 6 people. This made January the month with the second highest number (25) of avalanche deaths.

There were 9 avalanche deaths that were outside the normal range of avalanche activity from December to April. There were 4 deaths that occurred in both May and November, and one death that occurred in July. In November, two of the deaths were to skiers, while the other two were engaging in recreation of an unspecified nature. In May, all four of the deaths were to skiers, three of them being killed in the same avalanche in 1996. The person who was killed in July in an avalanche was likely mountain climbing, as the death occurred on Mt. Robson, and the deceased fell an unspecified distance to his death.

*Note: Number of avalanches that killed at least one person.

Avalanche deaths are difficult to examine by place of death because of multiple death avalanches that can greatly skew numbers. For this reason, it is helpful to look at both total avalanche deaths by LHA from 1985 to 1998, as well as the number of avalanches that killed at least one person by LHA. Kootenay Lake/Nelson was the LHA with the most deaths over the 1985 to 1998 period with 13 deaths, as well as being tied for the highest number of deadly avalanches, with 7. Golden also had 7 deadly avalanches between 1985 and 1998, but only 7 deaths. Other notable LHAs were Windermere and North Thompson, who experienced relatively few deadly avalanches with 2 and 3 respectively, but each had a very high number of deaths with 11 each. These high number of deaths were due to very tragic single avalanches, one which killed 9 skiers near Spillimacheen in Windermere and the other which killed 7 skiers near Blue River in North Thompson.

Forest Fires

The one death that was counted in this study was due to a 1991 forest fire near Clowhom Lake on the Sunshine Coast. In this case, flames overcame a fire fighter when the direction of the fire changed suddenly. Since it was not indicated that the fire was other than a natural occurrence, this event was counted in this study.

Excessive Heat

1986 and 1993 were the only years where there was more than one death (2 deaths) to excessive heat. As expected, all ten deaths occurred in the summer months between July and September (there were 3 deaths in July, 6 deaths in August and 1 death in September). Excessive heat claimed the lives of both men (7 deaths) and women (3 deaths) across a variety of ages. The youngest person to die of excessive heat was two years old, while the oldest was 69 years old.

Five of the 10 heat stroke deaths involved labour in the hot sun - 2 at construction sites, one on the highway, one while clearing land for a power line right of way, and another while performing a "physically demanding job, in hot weather after recent use of cocaine." Two others died in "closed-in rooms" in their own homes. The remaining 3 deaths included a lady with MS who collapsed in the sun outside her own home, a child exposed to outdoor rays, and a young man of 27 who died of heat stroke of unknown circumstances.

Wild Animal Attacks

Bears were responsible for the highest number of deaths in this group with 12 deaths. However, there were only 10 cases in which individual bears attacked humans, as in two cases the bear killed two people in the same attack. Half of these deaths were in the northern half of the province, four of which occurred in sparsely populated LHA 81, Fort Nelson. While deaths from bear attacks ranged across many ages from 1985 to 1998, 10 of the victims were males, while there were only 2 female fatalities.

Anaphylactic reactions to insect bites and stings caused the next highest number of deaths in this category. There were 9 deaths from 1985 to 1998 due to insects. Of these deaths, 4 were a result of wasp or yellow jacket stings, 3 were due to the bite or sting of an unknown insect, and 2 were the result of bee stings.

The only other species of wild animal to be responsible for human death between 1985 and 1998 was the cougar. Cougars killed a total of 3 people, two of which were children, while the other was a mother trying to protect her child. Children are more likely to be attacked by cougars than adults, as a child's size, high pitched voice, and rapid movements resemble those of a cougar's normal prey.

Lightning

Between 1985 and 1998 in BC, there were three individuals not so fortunate. These deaths were each due to direct lightning strikes. One of the deceased was running across a schoolyard soccer field when struck by a bolt, another was walking on a trail in a provincial park, and the third was struck while walking on a path on the side of a lake. The three fatal lightning strikes appeared to be random geographically.

Storms

Summary

Given the growing popularity of mountain sports such as snowboarding with young people and the increasing popularity of helicopter skiing in remote areas, it is reasonable to expect that fatal encounters with avalanches will increase over time. However, endeavours by organizations such as the Canadian Ski Patrol, the Canadian Avalanche Association (centred in Revelstoke BC), and Parks Canada to stress ski and snowboard safety to youth may help to prevent avalanche fatalities in the future, and counteract the effect of increasing numbers of people in avalanche areas.

Excessive cold and exposure deaths were by far the largest cause of death for Status Aboriginals in this study. Of a total of 50 Status Aboriginal deaths in all categories over all years, 46 of these deaths were due to excessive cold or exposure. Of the remaining 4 Status Aboriginal deaths, 2 were due to excessive heat, one was a wasp sting death, and one was an avalanche death.

Examination of circumstance and location from original records concerning death due to hypothermia/exposure, pointed to potential areas for prevention or intervention. On 5 records, information provided was vague as to the type of place and nature of the circumstances surrounding the death. Of the remaining 150 deaths, only 35 occurred in wilderness settings; 77% were in urban or rural communities. All "close to/at home" hypothermia/exposure deaths involved individuals who, for a variety of reasons, were subject to impaired judgement and/or physical or mental handicap. Alcohol intoxication was the largest contributor to these deaths; Alzheimers dementias, senility and other mental health disorders were also prominent. Less significantly, indigence or homelessness or a debilitating physical condition such as epilepsy or heart disease were also contributive factors to death from "community" hypothermia/exposure.

Among the 35 "wilderness" hypothermia/exposure deaths were 5 individuals who succumbed to winter weather conditions when their snowmobile or motor vehicle became inoperable. Four others died at a wilderness workplace: 8 wandered from companions or campsite, 6 of these while intoxicated, and two because of confusion caused by physical/mental disorders. Four hikers/climbers sustained injuries that left them stranded in the wilderness. The 14 remaining "wilderness" hypothermia/exposure fatalities were the result of individuals becoming lost or meeting with unexpectedly harsh climatic conditions. Only two of these were described as being inadequately clothed.

Glossary

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 (eg. lymphomas and leukemias, 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 sequential relationships of conditions and diseases from immediate cause backwards to underlying cause.

[Return to Table of Contents]

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 (January, 2000). Analysis of Health Statistics for Status Indians in British Columbia: . . . for British Columbia and Four Administrable Areas.

British Columbia Vital Statistics Agency, Ministry of Health, (1991-1999). Quarterly Digest. Vol.1 (1&2) to Vol.9 (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.

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

British Columbia Vital Statistics Agency (2000). Selected Vital Statistics and Health Status Indicators: One Hundred Twenty-Seventh Annual Report 2000. (available September 2000)

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., 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., 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., 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., (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., (1995) Suicide, Homicide, and Gun Deaths, British Columbia: 1985 to 1993. Division of Vital Statistics, Victoria, British Columbia.

[Return to Table of Contents]

Index of Quarterly Digest Articles to date

Volume 1 - Number 1 & 2 - October 1991

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

Volume 1 - Number 3 - January 1992

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

Volume 1 - Number 4 - April 1992

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

Volume 2 - Number 1 - July 1992

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

Volume 2 - Numbers 2 & 3 - November 1992

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

Volume 2 - Number 4 - February 1993

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

Volume 3 - Number 1 - May 1993

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

Volume 3 - Number 2 - August 1993

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

Volume 3 - Number 3 - November 1993

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

Volume 3 - Number 4 - May 1994

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

Volume 4 - Number 1 - June 1994

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

Volume 4 - Number 2 - August 1994

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

Volume 4 - Number 3 - November 1994

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

Volume 4 - Number 4 - February 1995

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

Volume 5 - Number 1 - May 1995

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

Volume 5 - Number 2 - August 1995

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

Volume 5 - Number 3 - November 1995

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

Volume 5 - Number 4 - March 1996

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

Volume 6 - Number 1 - July 1996

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

Volume 6 - Number 2 - October 1996

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

Volume 6 - Number 3 - January 1997

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

Volume 6 - Number 4 - April 1997

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

Volume 7 - Number 1 - July 1997

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

Volume 7 - Number 2 - October 1997

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

Volume 7 - Number 3 - January 1998

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

Volume 7 - Number 4 - May 1998

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

Volume 8 - Numbers 1 & 2 - December 1998

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

Volume 8 - Number 3 - March 1999

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

Volume 8 - Number 4 - August 1999

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

Volume 9 - Numbers 1 & 2 - October 1999

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

Volume 9 - Number 3 - March 2000

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

Volume 9 - Number 4 - June 2000

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

Topics in progress/planned

1. ICD-10 comparison, mortality rule changes, modifications; Issue paper(s) re - impact on data consistency and accuracy.
   
2. Tuberculosis and mycobacterium - Impact on Mortality.
   
3. Illicit drug deaths, 1993 to 1999.
   
4. Suicide in British Columbia, 1987 to 1999.

Editor's Note:

Standard mortality tables for the next issue (the first for year 2000) will be derived from new in use ICD-10 coding system. The BC Vital Statistics Agency has conducted surveys (re. cancer coding) of certifying physicians, examined output, documented rule changes and introduced many additional edits to maintain data quality and consistency of UCOD selection. Disease categories and death causes provided in our "Quarterly" standard mortality tables are being redone for the new coding system. Differences in code/code group representation between ICD-9 and ICD-10 will be documented but thanks to reasonable UCOD selection edits, the impact of the new coding system relative to historical data, will be considerably minimized.

Correction: There was an error in the 1999 population projections provided in Tables 1A and 1B in the previous publication (Vol. 9, No. 3). We had created a "tailor made" grouping (age 15 to18) for another project and neglected to remove the new group when population counts were generated for the "Quarterly". Apologies to anyone inconvenienced by our mistake and thanks to our reader who pointed out the error.

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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