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3 Potentially Avoidable Mortality

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


  • Potentially avoidable mortality is the sum of potentially treatable and potentially preventable deaths among persons under age 75.
  • The crude potentially avoidable mortality rate is the total number of potentially avoidable deaths per 100,000 population under age 75. 
  • An age-specific potentially avoidable mortality rate is the number of potentially avoidable deaths in a given age group per 100,000 population in that age group over a specified period of time.
  • The age-standardized potentially avoidable mortality rate is the rate (per 100,000) of potentially avoidable deaths that would occur in a given population if that population had the same age distribution as the 1991 Canadian population. 
  • The standardized potentially avoidable mortality ratio is the ratio of observed potentially avoidable deaths to the number that would be expected if the population had the same age-specific death rates as Ontario.

Specific Indicators

  • Crude Potentially Avoidable Mortality Rate
  • Age-Specific Potentially Avoidable Mortality Rate
  • Age-Standardized Potentially Avoidable Mortality Rate
  • Standardized Potentially Avoidable Mortality Ratio

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 endeavors 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.

Protocol Requirements Related to this Indicator:

The board of health shall collect or access the following types of population health data and information: Mortality, including death by cause (Population Health Assessment and Surveillance Protocol, 1b).

Goal Related to this Indicator:

To reduce the burden of preventable chronic diseases of public health importance. (Chronic diseases of public health importance include cardiovascular diseases, cancer, respiratory diseases, injuries, infections, digestive diseases, alcohol and drug use disorders, infant and maternal complications, nutritional, endocrine and metabolic disorders, and adverse effects of medical and surgical care).

Corresponding Indicators from Statistics Canada and CIHI

  • Potentially avoidable mortality

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: Cite 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

ICD Codes

Please refer to Potentially Avoidable Mortality ICD Code List.

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.
  • For IntelliHEALTH: 
    • Use Death data source from the 01 Vital Stats 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 (ICD10 Code, age group, sex, etc.). 
    • OR use standard reports
      1. “Premature and avoidable-preventable mortality – PHU” and
      2. “Premature and avoidable-treatable mortality – PHU” from the Standard Reports > 01 Vital Stats folder and add together for total potentially avoidable mortality.
    • 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 and filter to include only those <75 years.
    • In the mortality data set, External Cause of Injury Codes (ICD10 V-Y; ICD9 E-Codes), and not Injury & Poisoning Codes (ICD10 S-T codes; ICD9 800-999 codes) are used in assigning primary cause of death.  However for the years 1986-1999, the Injury and Poisoning ICD9 codes are also available and can be accessed from the "Nature of Injury" folder.  The Injury and Poisoning ICD10 codes (S-T) are not available for the years that ICD10 codes are used (beginning in 2000).
  • The following syntax files can be used to assist with calculations of this indicator:

Method of Calculation 

Crude Avoidable Mortality Rate:

total number of potentially avoidable deaths among those 0-74 years

total population aged 0-74 years
  X 100,000

Age-specific Mortality Rate:

total number of potentially avoidable deaths in an age group

total population in that age group
  X 100,000

SRATE (See Resources: Standardization of Rates):

Sum of (age-specific potentially avoidable death rate X 1991 Canadian population in that age group)

Sum of 1991 Canadian population aged 0-74 years
  X 100,000

SMR (See Resources: Standardization of Rates):

Sum of potentially avoidable deaths in the population for that age group

Sum of (Ontario age-specific rate X population in that age group)
  X 100,000

Basic Categories

  • Subgroups: potentially preventable mortality and potentially treatable mortality
  • Age groups: suggested age groupings are the chronic disease age groups (Age Group (CD) in Intellihealth -<1-19 yr, 20-44, 45-64, 65-74) or the infant + 5-yr age groups (Age Group (inf,5yr) in Inteallihealth - <1, 1-4, then 5 yr groups to 65-74).
  • Sex: male, female and total.
  • By cause of potentially avoidable mortality (e.g., cardiovascular disease, neoplasms, etc.)
  • Geographic areas of residence of deceased: Public Health Unit (PHU), Local Health Integration Network (LHIN), county, municipality

Indicator Comments

  • The concept of potentially avoidable mortality is based on the knowledge that some deaths can be avoided by either preventing the onset of disease or by preventing or delaying death once a disease or condition has developed.1 The potentially avoidable mortality indicator can therefore be divided into mortality from potentially preventable causes and mortality from potentially treatable causes: 
    • Mortality from potentially preventable causes refers to deaths that can be avoided by preventing a disease from developing. This includes deaths from conditions linked to modifiable risk factors, such smoking or excessive alcohol consumption (e.g., lung cancer, liver cirrhosis), and deaths linked to effective public health interventions (e.g., vaccinations, traffic safety legislation).
    • Mortality from potentially treatable causes refers to deaths from conditions where it is expected that death can be avoided or delayed by measures, such as screening, early detection, and appropriate treatment (e.g., breast cancer, appendicitis). 
  • Because potentially avoidable mortality is limited to causes of death where mechanisms of mortality are known, it can be considered more actionable than overall premature mortality indicators, which are commonly used in health status reporting.1
  • There is no standard definition of potentially avoidable mortality that is agreed upon internationally. The conditions included in the APHEO indicator and their classification as preventable or treatable are the same as those included in the Canadian potentially avoidable mortality indicator established by the Canadian Institute for Health Information (CIHI).1 However, not all conditions can be easily classified as preventable or treatable. In developing the Canadian indicator, when assigning avoidable deaths to one of the two subcategories (preventable or treatable), priority was given to prevention in cases where there were clear arguments for both categories. Exceptions were made for ischemic heart disease, stroke, diabetes, for which deaths were split 50/50 preventable and treatable.1 
  • The APHEO potentially avoidable mortality indicator classifies deaths due to cervical cancer (ICD-9 code 180, ICD-10 code C53) as treatable, consistent with the Canadian indicator. Other definitions of potentially avoidable mortality, however, may classify these deaths as preventable since screening for cervical cancer with the Pap test is able to detect pre-cancerous lesions and therefore reduce incidence. 
  • When interpreting results of the potentially avoidable mortality indicator, consideration should be given to the fact that not all deaths from potentially avoidable causes can actually be avoided.  Furthermore, the definition of avoidability can change over time with advances in preventive measures, such as screening, and treatments.1
  • The choice of the upper age limit used in calculating potentially avoidable mortality may vary across reports and may change over time. Age 75 used in the APHEO indicator is consistent with the age group used in the national indicator definition but is somewhat arbitrary as some deaths that occur in the population over age 75 can still be avoided.2
  • 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 Reference(s)

  1. Canadian Institute for Health Information, Statistics Canada. Health Indicators 2012. Ottawa: CIHI;2012 [cited 2014 Apr 7]. Available from:
  2. Office for National Statistics (United Kingdom).Avoidable mortality in England and Wales 2010. London: Crown; 2012 [cited 2014 Apr 7]. Available from:

Other Reference(s)

  1. Ministry of Health and Long-term Care. Maintaining the gains, moving the yardstick: Ontario health status report, 2011. Toronto, ON: Queen’s Printer for Ontario; 2013 [cited 2014 Apr 7]. Available from: 
  2. Ministry of Health. Saving Lives: Amenable Mortality in New Zealand, 1996-2006. Wellington, New Zealand: Ministry of Health; 2010 [cited 2014 Apr 7]. Available from:

Changes Made


Type of Review (Formal Review or Ad Hoc?)

Changes made by


June 2014

Indicator creation

Avoidable Mortality Subgroup of Core Indicators Working Group

  • New indicator created.

January 2015

Revisions based on reviewer feedback

Avoidable Mortality Subgroup of Core Indicators Working Group

  • Finalized new indicator
  • Posted updated SPSS syntax
February 2015

Revisions based on reviewer feedback

 Avoidable Mortality Subgroup of Core Indicators Working Group
  •  Posted updated STATA syntax


Lead Authors

Avoidable Mortality Subgroup

  • Jeremy Herring, Public Health Ontario
  • John Barbaro, Simcoe Muskoka District Health Unit
  • Elisa Candido, Cancer Care Ontario
  • Sherri Deamond, Durham Region Health Department
  • Ramsey D'Souza, North Bay Parry Sound District Health Unit
  • Andrew Harris, Haliburton Kawartha Pine Ridge District Health Unit
  • Carley Aubin, Halton Region Health Department
  • Robert Barnett, North East Community Access Centre
  • Michael King, Sudbury & District Health Unit

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