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4C Fall-Related Mortality

Description | Specific Indicators | Ontario Public Health Standards | Corresponding Health Indicator(s) from Statistics Canada and CIHI | Corresponding Indicator(s) from Other Sources | Data Sources |  ICD Codes | Alternative Data Sources |  Analysis Check List | Method of Calculation |  Basic Categories |  Indicator Comments | Cross-References to Other Indicators | Cited References  | Changes Made | Acknowledgements


  • Crude mortality rate  - the total number of unintentional fall-related deaths relative to the total population during a given year (fiscal or calendar) (usually expressed per 100,000). 
  • Age-specific mortality rates  - the total number of unintentional fall-related deaths in a given age group per population in that age group during a given year (fiscal or calendar) (usually expressed per 100,000).
  • Age-standardized mortality rate (SRATE) for unintentional fall-related injury - the number of unintentional fall-related deaths per 100,000 population that would occur in the population if it had the same age distribution as the 1991 Canadian population.
  • Standardized mortality ratio (SMR) - the ratio of observed unintentional fall-related deaths to the number expected if the population had the same age-specific mortality rates for unintentional falls as Ontario.


Specific Indicators
  • Crude mortality rate for unintentional fall-related injury
  • Age-specific mortality rates for unintentional fall-related injury
  • Age-standardized mortality rate for unintentional fall-related injury
  • Standardized mortality ratio for unintentional fall-related injury


Ontario Public Health Standards (OPHS)

The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.


Outcomes Related to this Indicator
  • Board of Health Outcome (Prevention of Injury and Substance Misuse): the board of health is aware of and uses epidemiology to influence the development of healthy public policy and its programs and services for the prevention of injury and substance misuse.
  • Board of Health Outcome (Foundational Standard): the public, community partners and health care providers are aware of relevant and current population health information.
Assessment and Surveillance Requirements Related to this Indicator (Prevention of Injury and Substance Misuse)
  • The board of health shall conduct epidemiological analysis of surveillance the areas of injury and substance misuse outcomes, including falls across the lifespan.


Corresponding Health Indicator(s) from Statistics Canada and CIHI

  • None


Corresponding Indicator(s) from Other Sources
  • None


Data Sources (see Resources: Data Sources)

Mortality Data
Original source: Vital Statistics, Ontario Office of Registrar General (ORG), ServiceOntario
Distributed by: Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)
Suggested citation (see Data Citation Notes): Death [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].

Denominator: Population Estimates
Original source: Statistics Canada
Distributed by: Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)
Suggested citation (see Data Citation Notes): Population Estimates [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].

ICD Codes
  • Unintentional Fall Codes (ICD-9: E880-E888); (ICD-10: W00-W19):
    • W00: Fall on same level involving ice and snow
    • W01: Fall on same level from sliping, tripping or stumbling
    • W02: Fall involving ice-skates, skis, sport boards and in-line skates
    • W03: Other fall on same level due to collision with, or pushing by, another person
    • W04: Fall while being carried or supported by another person
    • W05: Fall involving wheelchair and other types of devices
    • W06: Fall involving bed
    • W07: Fall involving chair
    • W08: Fall involving other furniture
    • W09*: Fall involving playground equipment
    • W10: Fall on and from stairs and steps
    • W11: Fall on and from ladder
    • W12: Fall on and from scaffolding
    • W13: Fall from, out of or through building or structure
    • W14: Fall from tree
    • W15: Fall from cliff
    • W16: Diving or jumping into water causing injury other than drowning or submersion
    • W17: Otherfall from one level to another
    • W18: Other fall on same level
    • W19: Unspecified fall

*Prior to the year 2009, the only code available for 'falls involving playground equipment' was W09.  From 2009 and onwards, subcategories were introduced (eg. W09.03 is fall involving teeter totter) and code range for falls involving playground equipment is from W09.01-W09.09.  


Alternative Data Sources 
  • Ontario Trauma Registry


Analysis Check List  
  • The IntelliHEALTH licensing agreement does not require suppression of small cells, but caution should be used when reporting at a level that could identify individuals, (e.g. reporting at the postal code level by age and sex). Please note that privacy policies may vary by organization. Prior to releasing data, ensure adherence to the privacy policy of your organization.
  • Aggregation (e.g. combining years, age groups, categories) should also be considered when small numbers result in unstable rates.
  • IntelliHEALTH Ontario is developing a complete set of pre-defined reports for injury-related Core Indicators, (i.e., templates that permit standardized queries by local public health agencies). Registered IntelliHEALTH users can find a predefined report called 'Mortality - Injury External Causes - indicator data list' in the APHEO Public Health Indicator folder in the Standard Reports section.  This report will provide all injury-related deaths, to get only fall-related deaths, please filter for fall codes W00-W19 as described below.
  • For IntelliHEALTH:
    • Use Deaths data source from the Vital Statistics folder in IntelliHEALTH, select # Dths (ON res) measure (number of deaths for Ontario residents who died in Ontario). Note: deaths for Ontario residents who died outside the province are not captured in Vital Statistics.
    • Select appropriate geography from Deceased Information folder (public health unit or LHIN). Include other items, depending on your requirements (age group, year, sex, etc.).  Also include 'ICD10 Code Primary Cause' if you wish to view the detailed fall code descriptions.
    • To capture falls-related mortality, filter on ‘ICD10 Code (3 char) Primary Cause'= is between values (inclusive) W00 to W19. 
    • In the mortality data set, External Cause of Injury Codes (ICD-10 V-Y; ICD9 E-Codes), and not Injury & Poisoning Codes (ICD-10 S-T codes; ICD9 800-999 codes) are used in assigning primary cause of death.  The External Cause of Injury Codes describe how the injury occurred (eg. fall), whereas the Injury and Poisoning Codes describe the nature or type of injury sustained by the person (eg. fracture of hip). 
    • For population estimates to be used in the calculations below, use the Population Estimates County PHU Municipality or the Population Estimates and Projections LHIN data source in the Populations folder in Intellihealth; select the # people measure and the appropriate geography (PHU or LHIN), age group(s), and sex.
    • Please note that the Mortality dataset uses ICD-10 codes which can have a maximum length of 4 digits, instead of ICD-10-CA codes which can be up to 5 digits long.
    • 'Place of occurrence' may also be used for codes W00-Y34 to identify place of external cause.  Please note that there may be a large number of patient records where place of occurrence is missing or categorized as ‘9', unspecified place.
  • HELPS Data: Historically, PHUs obtained data for deaths from the Ministry of Health through HELPS (the HEalthPlanning System). Although these data are no longer commonly used, some PHUs may still be accessing these data files. Information about the data can be found in the HELPS Data Source resource. 


Method of Calculation 

Crude Rate

total number of unintentional fall-related deaths

    x 100,000

total population


Age-Specific Rate

total number of unintentional fall-related deaths in an age group  

    x 100,000

total population in that age group


SRATE (See Resources: Standardization of Rates) 

sum of (age-specific unintentional fall-related death rate X1991Canadian population in that age group) 

    x 100,000

sum of 1991 Canadian population

SMR (See Resources: Standardization of Rates)

sum of unintentional fall-related deaths in the population for an age group


sum of (Ontario age-specific rate X population in that age group)

Basic Categories
  • Suggested Age Groups:
    • <1-19 yr, 20-44, 45-64, 65-74, 75+. (IntelliHEALTH Chronic Disease age groups -Age Group (CD)) or
    • <1, 1-4, then 5 yr groups to 90+. (IntelliHEALTH Infant + 5-yr age groups - (inf,5yr))
      *Note: Health units may choose to merge age categories due to small numbers, or change age categories depending on the specific analysis questions. Examples of other potential age categories include:
      • '<1, 1-4 could be changed to "0-4"
      • ‘Youth' could be analyzed as '15-24', a common category for analyzing self-harm data
      • ‘Seniors/Older adults' could be analyzed as ages "65+"
  • Sex: male, female and total
  • Geographic areas of residence: Ontario, public health unit, municipality, and smaller areas of geography based on aggregated postal code


Indicator Comments  
  • Unintentional fall is the leading cause of injury death in those 65 years of age and older (1).
  • Deaths from unintentional fall-related injuries account for three quarters of in-hospital deaths among those admitted for unintentional injury (2).
  • The rate of hospitalization and mortality related to falls is higher in senior women than senior men (3) and increases with increasing age after age 65 (3, 4).
  • The mechanism of fall, (i.e., how falls occur), varies across age groups (1). It may be informative to analyze falls by external cause. Please refer to ICD10 codes.
  • A study of death certificates identifying multiple causes of death found that accidental falls was never the underlying cause and was on average associated with four other diagnoses. To some extent this is because those who died of accidental fall tended to be elderly and thus had a variety of other conditions (5).
  • ICD-10-CA has a greater level of specificity and different code titles than ICD-9. CIHI does not endorse forward conversions because of differences in the classification systems. Refer to Resources: ICD-10-CA for more information.
  • To best understand mortality or disease trends in a population, it is important to determine crude rates, age-specific rates and age-standardized rates (SRATES) and/or ratios (SMRs, SIRs). Although the crude death (or disease) rate depicts the "true" picture of death /disease in a community, it is greatly influenced by the age structure of the population: an older population would likely have a higher crude death rate. Age-specific rates can best describe the "true" death/disease pattern within particular age groups of a community, and allow for comparison of age groups across populations that have different age structures.
  • Since many age-specific rates are cumbersome to present, age standardized rates have the advantage of providing a single summary number that allows different populations to be compared; however, they present an "artificial" picture of the death/disease pattern in a community. For more information about standardization, refer to the Resources section: Standardization of Rates.


Cross-References to Other Indicators


Cited References
  1. Minino AM, Anderson RN. Deaths: injuries, 2002. Natl Vital Stat Rep. 2006 [cited 2012 Jun 26]; 54(10):1-124. Available from:
  2. Canadian Institute for Health Information. National Trauma Registry 2006 injury hospitalizations highlights report. Ottawa: Canadian Institute for Health Information; 2007 [cited 2012 Jun 26]. Available from:
  3. Public Health Agency of Canada. Report on seniors' falls in Canada. Ottawa: Her Majesty the Queen in Right of Canada; 2005 [cited 2012 Jun 26]. Available from:
  4. British Columbia Ministry of Health Planning. Prevention of falls and injury among the elderly. Victoria: British Columbia Ministry of Health Planning, Office of the Provincial Health Officer; 2005 [cited 2012 Jun 26]. Available from:
  5. Wilkins K, Wysocki M, Morin C, Wood P. Multiple causes of death. Health Reports. 1997;9(2):19-29.


Changes Made


Type of Review (Formal Review or Ad Hoc?)

Changes made by


July 16,  2012

Formal review

Injury and Substance Misuse Prevention Work Group

  • Updated indicator to include falls throughout the lifespan, in line with the OPHS.
  • Updated OPHS information.
  • Updated 'Data Source' information reflect use of IntelliHEALTH Ontario
  • Revised 'Basic Categories' section to reflect categories available through IntelliHEALTH Ontario
  • Updated indicator comments and cited references.



Lead Author(s)

  • Badal Dhar, Public Health Ontario
  • Natalie Greenidge, Public Health Ontario

Contributing Author(s)

  • Injury and Substance Misuse Prevention Subgroup
    • Suzanne Fegan, KFL&A Public Health (Subgroup Lead)
    • Christina Bradley, Niagara Region Public Health
    • Jeremy Herring, Public Health Ontario
    • Sean Marshall, Public Health Ontario
    • Jayne Morrish, Parachute
    • Lee-Ann Nalezyty, Northwestern Health Unit
    • Michelle Policarpio, Public Health Ontario
    • Narhari Timilshina, Toronto General Hospital


  • Celine Butler, Timiskaming Health Unit
  • Julie Stratton, Region of Peel Health Department
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