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

Description

• The crude mortality rate is the total number of deaths in a given year relative to the total population for that year (per 100,000).
• Age-specific mortality rate is the number of deaths in a given age group per 100,000 population in that age group over a specified period of time. 
• Age-standardized mortality rate (SRATE): the number of deaths that would occur for a given population if that population had the same age distribution as the 1991 Canadian population (per 100,000).
• Standardized mortality ratio (SMR): the ratio of observed deaths to the number expected if the population had the same age-specific death rates as Ontario.

Specific Indicators

• Crude Mortality Rate
• Age-Specific Mortality Rate
• Age-Standardized Mortality Rate (SRATE)
• Standardized Mortality Ratio (SMR)

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, and type 2 diabetes).

http://www.ontario.ca/publichealthstandards

Corresponding Indicators from Statistics Canada and CIHI

• Total mortality by selected causes

http://www.statcan.ca/bsolc/english/bsolc?catno=82-221-X 

Click on "view" beside "Free", "Latest issue".
Click on "Data tables and maps" on the left side menu.
Click on the indicator "Total mortality by selected causes" under Health Status, Deaths.

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 "Leading Cause Groups for Mortality Tabulation."

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.
• If small numbers are an issue multiple years of data may be summed in the numerator to create a more stable rate. In this case, be sure to sum an equal number of years of population data for the denominator.
• For IntelliHEALTH:
• 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.
• 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).

Method of Calculation 

Basic Categories

• 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, 75+) or the infant + 5-yr age groups (Age Group (inf,5yr) in Inteallihealth - <1, 1-4, then 5 yr groups to 90+).
• Sex: male, female and total.
• ICD Chapter
• Leading Cause Groups for Mortality (Becker, APHEO)¹
• 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

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.
Mortality reflects the upper limit of the disease severity continuum.
Analysis by ICD Chapter provides a general overview.
Analysis by Leading Cause Group provides a more specific breakdown (e.g. ischaemic heart disease and stroke vs. all cardiovascular disease) within (and sometimes between) chapters.

Cross-References to Other Indicators

• 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 (Section 6B: Reproductive Health)
• Child and Adolescent Mortality (Section 6C: Child and Adolescent Health)
• Suicide Mortality (Section 7: Mental Health)
• Infectious Disease Mortality (Section 8: Infectious Diseases)

Cited Reference(s)

1. Becker R, Silvi J, Ma Fat D, L'Hours J, Laurenti R. A method for deriving leading causes of death. WHO Bulletin April 2006; 84(4): 297-303, Appendices A-D. Available online at: http://www.who.int/bulletin/volumes/84/4/297.pdf (Accessed March, 2009).

• Frank J. Causes of death: how the sexes differ. Canadian Social Trends 1996; 41:4-10.
• Gilmour H, Gentleman JF. Mortality in metropolitan areas. Health Reports 1999; 11(1):9-19.
• Nault F. Narrowing mortality gaps, 1978 to 1995. Health Reports 1997;9(1):35-42.
• Wilkins K, Wysocki M, Morin C, Wood P. Multiple causes of death. Health Reports 1997; 9(2):19-29.
• Statistics Canada. Deaths - Shifting Trends. Health Reports 2001; 12(3):41-46. Available at: http://www.statcan.gc.ca/studies-etudes/82-003/archive/2001/5628-eng.pdf.
• Wilkins R, Tjepkema M, Mustard  C, Choinière R. The Canadian census mortality follow-up study, 1991 through 2001. Health Reports 2008; 19(3):25-43. Available at: http://www.statcan.gc.ca/pub/82-003-x/2008003/article/10681-eng.pdf.
• Trends in mortality by neighbourhood income in urban Canada from 1971 to 1996. Wilkins R, Berthelot J-M, Ng E. Health Reports 2002; 13(Suppl.):45-71. Available at: http://www.statcan.gc.ca/pub/82-003-s/2002001/pdf/82-003-s2002007-eng.pdf.
• Leading Causes of Death in Canada, 2007. Statistics Canada. November 30, 2010. Available at: http://www.statcan.gc.ca/pub/84-215-x/84-215-x2010001-eng.htm

Changes Made