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8 Infectious Disease Mortality

Description | Specific Indicators | Corresponding OPHS Outcomes | 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 | Acknowledgements | Changes Made 
  • The crude mortality rate is the total number of deaths each from infectious diseases relative to the total population (per 100,000) in a specified time period.
  • Age-specific mortality rates for  infectious diseases are the number of deaths in a given age group from infectious diseases per 100,000 population in that age group in a specified time period.
  • Age-standardized mortality rates (SRATEs) for infectious diseases: the number of deaths from infectious diseases per the population that would occur if the population had the same age distribution as the 1991 adjusted Canadian population.
  • Standardized mortality ratios (SMRs) for infectious diseases: the ratio of observed deaths of infectious diseases to the number expected if the population had the same age-specific death rates as Ontario.


Specific Indicators
  • Infectious diseases mortality rate

Corresponding Outcomes from the 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.

Link to OPHS

Outcomes Related to this Indicator

  • Societal Outcome (Infectious Diseases Prevention and Control): There is reduced morbidity and mortality associated with infectious diseases of public health importance. 
  • Societal Outcome (Sexual Health, Sexually Transmitted Infections, and Blood-borne Infections (including HIV): There is reduced morbidity and mortality associated with sexually transmitted infections and blood-borne infections.

Corresponding Health Indicator(s) from Statistics Canada and CIHI

The Internet publication Health Indicators, produced jointly by Statistics Canada and the Canadian Institute for Health Information, provides over 80 indicators measuring the health of the Canadian population and the effectiveness of the health care system. Designed to provide comparable information at the health region and provincial/territorial levels, these data are produced from a wide range of the most recently available sources. 

Data Sources

Numerator: Mortality Data
Original source: Ontario Office of Registrar General (ORG)
Distributed by: Ontario Ministry of Health and Long-Term Care: IntelliHEALTH ONTARIO
Suggested citation (see Data Citation Notes): Ontario Mortality Data [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: IntelliHEALTH ONTARIO
Suggested citation (see Data Citation Notes): Population Estimates [years]*, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].
* Note: To indicate which versions were used, include all the 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.
ICD Codes

  • Chapter 1: Infectious and Parasitic Diseases; and Pneumonia & Influenza (ICD-9: 001-139, 480-487); Chapter 1: Certain infectious and parasitic diseases; and Influenza and pneumonia  (ICD-10: A00-B99, J09-J18)


Alternative Data Sources
  • Hospitalization data from Provincial Health Planning Database where death occurs in hospital.
  • iPHIS


Analysis Check List
  • Consider aggregation of data values and/or cell suppression when dealing with small numbers to avoid risk of confidentiality breach. A new resource is currently under development to provide more detailed information on this issue.
  • Use Deaths data source from the Vital Statistics folder in Intellihealth, select # ON Deaths 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 (ICD10 Chapter, Lead Cause Group, age group, sex, etc.).
  • For population estimates, 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.

Method of Calculation 

Crude Mortality Rate:

total number of deaths by ICD code in a specified time period

    x 100,000

total population in a specified time period

Age-Specifice Mortality Rate:

total number of deaths by ICD code in an age group in a specified time period

    x 100,000

total population in that age group in a specified time period

Age Standardized Mortality Rate (See Resources: Standardization of Rates):

Sum of (age-specific death rate by ICD code x 1991 Canadian population in that age group in a specified time period)

    x 100,000

(Sum of 1991 Canadian population in a specified time period)

Standardized Mortality Ratio (SMR) (See Resources: Standardization of Rates):

(Sum of deaths by ICD code in the population in a specified time period)


Sum of (Ontario age-specific rate x population in that age group) in a specified time period

Basic Categories

  • Age groups for age-specific rates: <1, 1-4, 5-9, 10-19, 20-44, 45-64, 65-74, 75+, total
  • Sex: male, female
  • Geographic areas of residence of deceased: Local Health Integration Network (LHIN), public health unit, county, municipality, forward sortation area (1996 onward) and postal code (1996 onward).

Indicator Comments

  • Influenza is a viral infection that may cause pneumonia and death among elderly persons and those with cardiovascular or pulmonary disease conditions.
  • Influenza & Pneumonia is treated as a combined category since the confirmation of influenza as the causative agent can be difficult and under-represents the number of cases.
  • Peaks of death due to influenza usually occur in January through March each year.
  • The Mandatory Programs and Service Guidelines suggest that pneumonia and influenza data be presented as a five year moving average. The moving average hides the seasonal and annual fluctuations, which are important to consider. There may also be an artificial decrease in the pneumonia and influenza death rates between 1999-2000 due to the change in ICD-9 and ICD-10 coding of pneumonia and flu deaths. This would also be masked in a moving average analysis.
  • Death due to an infectious disease may not be accurately reflected on the death certificate. Use with caution. See Mortality Data resource for more details.
  • 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

Other References

  • Evans AS, Brachman PS. Bacterial Infections in Humans: Epidemiology and Control. Springer, 1998.
  • Evans AS, Kaslow RA. Viral Infections of Humans: Epidemiology and Control. Springer, 1997.
  • Heymann DL. Control of Communicable Diseases Manual. American Public Health Association, 2004.
  • National Advisory Committee on Immunization. Canadian Immunization Guide, Seventh Edition, 2006. Ottawa, ON: Public Health Agency of Canada, 2006. Available at


Lead Author(s)

Sherri Deamond, Durham Region Health Department
Stephanie Wolfe, Simcoe Muskoka District Health Unit

Contributing Author(s)

Core Indicators Infectious Disease Subgroup

CIWG Reviewers

Core Indicators Infectious Disease Subgroup

External Reviewers

Effie Gournis, Toronto Public Health
Elizabeth Rea, Toronto Public Health
Rachel Savage, Ontario Agency for Health Protection and Promotion


Changes Made


Type of Review

(Formal or Adhoc)

Changes made by


Nov. 25, 2008


Infectious Disease subgroup

  • Removed tuberculosis, AIDS and pneumonia and influenza as a specific causes and changed to an all infectious disease grouping.
Nov. 22, 2010 Ad hocSherri Deamond on behalf of CIWG
  • Added J09 (Avian Influenza) to list of ICD-10 codes for Influenza and pneumonia  
June 13, 2011Ad hocSherri Deamond on behalf of CIWG
  •  Added Acknowledgements section
July 2, 2013Ad hocNatalie Greenidge on behalf of the CIWG
  • Updated indicator comments related to standardization of rates


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