Description | Specific Indicators | Corresponding Mandatory Objectives | Corresponding National Indicators | Data Sources |  Alternative Data Sources | ICD Codes | Analysis Check List | Method of Calculation |  Basic Categories | Indicator Comments | Cross-References to Other Sections | References  
 

Description

• Age-specific mortality rates for all causes are the annual number of deaths in a given age group per the population in that age group (usually expressed per 100,000).

• Age-specific mortality rates for selected causes are the annual number of deaths in a given age group from selected causes per the population in that age group (usually expressed per 100,000).

Specific Indicators

• Child and Adolescent Death Rate
• Injury and Poisoning Death Rate for Children and Adolescents
• Childhood Cancer Rate
• Respiratory Disease Death Rate for Children and Adolescents
• Congenital Anomaly Death Rate
• Infectious Disease Death Rate for Children and Adolescents
• Sudden Infant Death Syndrome Rate
• Homicide Rate for Children and Adolescents

• None

Corresponding National Indicators

• None

Data Sources (see Resources: Data Sources)

Numerator: Mortality Data
Original source: Ontario Office of Registrar General (ORG)
Distributed by: Provincial Health Planning Database (PHPDB), Ontario MOHLTC
Suggested citation (see Data Citation Notes):
Ontario Mortality Data [years], Provincial Health Planning Database (PHPDB) Extracted: [date], Ontario MOHLTC

Denominator: Population Estimates
Original source: Statistics Canada
Distributed by:
Provincial Health Planning Database (PHPDB), Health Planning Branch, Ontario MOHLTC
Suggested citation (see Data Citation Notes):
Population Estimates [years]*, Provincial Health Planning Database (PHPDB) Extracted: [date], Health Planning Branch, Ontario MOHLTC
* Note: Use the total years of the estimates, including the most recent year, even if not all were used in the analysis. The years used in the analysis should be included in the report itself.

Alternative Data Source

Hospitalization Data
Hospitalization data from the Provincial Health Planning Database where death occurs in hospital
(exit code = X). Many deaths would be captured by hospitalization data where the person died in hospital; however, some important causes such as Sudden Infant Death Syndrome may be missed because these children would not have been admitted to hospital.

ICD-9 and ICD-10 Codes for Selected Diseases

Survey Questions

• None

Analysis Check List

• Suppress numbers <5 or rates and proportions based on counts less than 5.

• For PHPDB: 
  - Use Deaths table from Vital Statistics section of model, use Count All function under Query/Modifiers tabs. 
  - Select on geography of “Where Deceased Lived” (geography could be postal code, postal code FSA, province, county-municipality, county, region, district health council or public health unit) using geography code not geography name. If geography code is not known, “Prompts” can be used or codes can be looked up in “Geo Names” Code Table. Geography of “Where Death Occurred” can also be selected if desired.

• In mortality data, ICD-9 codes 800-999 refer to the External Causes of Injury and Poisoning codes (e-codes) unlike in hospital data where these codes refer to the Chapter XVII, Injury and Poisoning codes. In the mortality data set, Injury and Poisoning codes can be accessed from the “Nature of Injury” attribute/variable.

• 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.

Method of Calculation 

Child and Adolescent Death Rate:

Child and Adolescent Death Rate for Selected Causes:

Basic Categories

• Age groups for age-specific rates: <1 (infants), 1-9 years (children), 10-19 (adolescents), 0-19 (total children & adolescents).
• Sex: male, female.

• Geographic areas: public health unit, district health council, census division, census sub-division

Indicator Comments

• Age-specific rates are used rather than age standardized rates when examining childhood mortality. Because of the small number of deaths in children and adolescents, mortality from selected causes is generally examined by grouping rates into five or ten year time periods.

• “Children” and “adolescents” are defined by different age groups, depending upon the data source. For this mortality indicator, infants are defined as age less than one year, children as 1-9 years and adolescents as 10-19 years; these age groupings match population estimates (used for the denominators) which are reported by five-year age groups. Other common definitions include:
  - Infant (< 1 year), preschool children (1-4 years), school-aged children (5-14 years), youth (15-19 years)¹
  - Prenatal and infancy (conception to 18 months), preschoolers (18 months to age 5), school-age children (6-12 years), Adolescence (13-18 years)²
  - Healthy Babies Healthy Children (0-6 years) – Ministry of Health and Long-Term Care.³
  - Early Child Development program (0-6 years) – Ministry of Children and Youth Services.⁴
  - Child (1-9 years)⁵
  - Children and youth (0-19 years)⁶
  - Children (0-19 years) – Canadian Cancer Statistics⁷

• The Report on the Health Status of the Residents of Ontario found that the leading causes of death in Ontario children aged 1-9 years in 1991-1995 were: injury and poisoning (36%), cancer (15%), congenital anomalies (11%), nervous system (8%), circulatory system (5%), respiratory (5%), and all others (19%).⁵ For 1995 only, the leading causes of death for children aged 1-9 years old were: 1) motor vehicle accidents, 2) congenital anomalies, and 3) homicide. For adolescents aged 10-19 years old the leading causes of death in 1995 were 1) motor vehicle accidents, 2) suicide, and 3) lymphatic & haematopoietic cancer.⁵

• ICD-10-CA was introduced into Ontario mortality data in 2000. 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. 
  Injury:
  - Mortality statistics are commonly used to obtain an overall picture of injury; however, it provides no information on the number and severity of non-fatal injuries. 
  - ICD-9: The ICD-9 uses two sets of codes to classify injury. One set (Chapter XVII-Injury and Poisoning) considers the nature of the injury and corresponds to the underlying cause of death, e.g., fracture of vault of skull. The second set of codes are external cause or “E” codes which classify the environmental events, circumstances and conditions as the cause of the injury, e.g., motor vehicle traffic injury. The E-codes are the principal means for classifying injury deaths. The grouping of unintentional injury deaths excludes e-codes for “misadventures to patients during surgical and medical care”. This coding matches that used for the National Indicators. If appropriate, “E” codes are classified on the death certificate as the underlying cause of death, which is, in turn, selected for tabulation of the official cause of death statistics. 
  - ICD-10-CA: Chapter XX – external causes of morbidity and mortality (V01-Y98) permits the classification of environmental events and circumstances as the cause of injury, poisoning and other adverse effects. Where a code from this section is applicable, it is intended that it shall be used in addition to a code from another chapter of the Classification indicating the nature of the condition. Most often, the condition will be classifiable to Chapter XIX – Injury, poisoning and certain other consequences of external causes (S00-T98). Causes of death should preferably be tabulated according to both Chapter XIX and Chapter XX, but if only one code is tabulated then the code from Chapter XX should be used in preference. Other conditions that may be stated to be due to external causes are classified in Chapters I to XVIII. For these conditions, codes from Chapter XX should be used to provide additional information for multiple-condition analysis only.⁸
  - Deaths occurring several hours or days after an accident that did not require hospitalization may not be assigned an external cause code even though the death was the result of an injury. 

• Childhood cancer mortality (and incidence) is typically reported for ages 0-14 years, although sometimes for 10-19 years. Childhood cancer mortality rates have decreased by 4% per year in Canada over the last 25 years. The decline is largely attributable to improvements in treatment, particularly for acute lymphocytic leukemia. The leading causes of cancer deaths in Canadian children 0-14 from 1985-1996 were leukemia (36%), tumours of the brain and central nervous system (26%), neuroblastomas (11%), and lymphomas (6%).⁶

• Sudden Infant Death Syndrome (SIDS):
  - An objective in the draft Mandatory Health Programs and Services Guidelines (January 2003 version) is that “the infant mortality rate due to Sudden Infant Death Syndrome (SIDS) will be reduced”. 
  - Sudden Infant Death Syndrome (SIDS) is the unexpected death of an apparently healthy infant that remains unexplained after a complete post-mortem investigation, which includes an autopsy, death scene investigation and review of the medical history.⁹
  - Risk factors for SIDS include: babies who sleep on their tummies (6.6x); babies who sleep on their sides (2x); smoking during pregnancy (3x); exposure to second-hand smoke (2x); overheating; cluttered sleeping area; soft sleeping surface (increases with tummy sleeping); boys slightly more than girls; aboriginal (3x); substance abuse during pregnancy; teen mothers; mothers with late or no prenatal care; preterm infants (before 37 weeks gestation); low birthweight infants (under 2500 g); multiples (twins, triplets, etc.); mild respiratory infections; unaccustomed tummy sleepers (18-20x).⁹
  - The incidence of SIDS has decreased significantly over the past several years in countries that have had successful educational campaigns to reduce prone sleeping.

• Shaken Baby Syndrome (SBS):
  - An objective in the draft Mandatory Health Programs and Services Guidelines (January 2003 version) is that “the morbidity and mortality rates due to Shaken Baby Syndrome will be reduced”.
  - Shaken Baby Syndrome is a condition that occurs when an infant or young child is shaken violently, usually by a parent or a caregiver. Determining the number of deaths by Shaken Baby Syndrome is difficult. The incidence of Shaken Baby Syndrome may be severely underestimated due to missed diagnosis and underreporting.¹⁰
  - Rather than focus solely on Shaken Baby Syndrome, it may more appropriate to report the homicide rate for children and adolescents. Because numbers are small, it is necessary to group many years of data. The Report on the Health Status of the Residents of Ontario did report homicide as the 3^rd leading cause of death among 1-9 year olds in 1995 (12 deaths),⁵ which was higher than in other years.

Definitions

Infant = age <1 year
Children = 1-9 years
Adolescent = 10-19 years
 

Cross-References to Other Sections

• All-Cause Mortality (Section 3: Mortality, Morbidity, Health-Related Quality of Life)
• Chronic Disease Mortality (Section 4A: Chronic Diseases)
• Cancer Mortality (Section 4B: Cancer Incidence and Early Detection of Cancer)
• Injury Mortality (Section 4C: Injury Prevention and Substance Abuse Prevention)
• Perinatal Mortality Rate, Infant Mortality Rate (Section 6B: Reproductive Health)
• Suicide Mortality (Section 7: Mental Health)

• Infectious Disease Mortality (Section 8: Infectious Diseases)

References

1. Canadian Institute of Child Health. The Health of Canada’s Children: A CICH Profile, 3^rd edition, 2000.

2. Healthy Babies Healthy Children, Ministry of Health and Long-Term Care http://www.health.gov.on.ca/english/providers/pub/child/hbabies/hbabies_update.html

3. Ontario Early Years Initiatives, Ministry of Children and Youth Services. http://www.children.gov.on.ca/CS/en/programs/EarlyYearsInitiatives/default.htm

4. Public Health Research, Education and Development Program (PHRED). Report on the Health Status of the Residents of Ontario. February 2000.

5. Health Canada. Rusen ID, McCourt C (Eds.) Measuring Up: A Health Surveillance Update on Canadian Children and Youth. Minister of Public Works and Government Services Canada, 1999. Available at: http://www.phac-aspc.gc.ca/publicat/meas-haut/

6. National Cancer Institute of Canada. Canadian Cancer Statistics, 2008. Available at: http://www.cancer.ca/ccs/internet/standard/0,2283,3543_14279__langId-en,00.html

7. Canadian Institute for Health Information. ICD-10-CA/CCI CD, Version 2003. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA), 2003.

8. Health Canada. Sudden Infant Death Syndrome (SIDS): Information. Available at: http://www.phac-aspc.gc.ca/dca-dea/prenatal/sids-js_e.html.

9. Health Canada. Joint Statement on Shaken Baby Syndrome. Available at: http://www.phac-aspc.gc.ca/dca-dea/publications/jointstatement_web_e.html.

Date of Last Revision: June 29, 2004