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

Description

• The total mortality rate (crude rate) is the total number of deaths from selected malignant cancers relative to the total population (per 100,000) over a specified period of time.
• Age-specific mortality rate for a selected cancer is the annual number of deaths in a given age group from a selected cancer per 100,000 population in that age group over a specified period of time.  
• Age-standardized mortality rate (SRATE) for selected cancer is the number of deaths from a selected cancer that would occur if the population had the same age distribution as the 1991 Canadian population (per 10,000 or 100,000) over a specified period of time.  
• Standardized mortality ratio (SMR) for a selected cancer is the ratio of observed deaths to the number expected if the population had the same age-specific death rates as Ontario.

Specific Indicators

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.

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).

       http://www.ontario.ca/publichealthstandards

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.

http://www.statcan.gc.ca/start-debut-eng.html

Click on Publications.
Type in ‘Health Indicators' into search box.
Scroll down and click on the most recent html version of ‘Health Indicators'.
Click on "Data Tables and Maps" and then "Total Mortality by Selected Causes"

• Crude rate and age-standardized rate of death from cancer per 100,000 population: for all cancers (ICD-10 C00-C97) and for specific sites: colorectal (ICD-10 C18-C21), lung/bronchus (ICD-10 C33-C34), female breast (ICD-10 C50), and prostate cancer (ICD-10 C61).
• National Indicators are based on three years of data in both numerator and denominator. Three years of death data are divided by three times the mid-year population estimate. The title refers to the middle year.
• Death data have been linked to health regions using postal codes reported with place of residence and converted to census geography using the automated geo-coding system (PCCF Plus) developed by the Health Statistics Division of Statistics Canada. These data were then aggregated to health region based on correspondence files developed by the Health Statistics Division with the cooperation of provincial Ministries of Health, Alberta Treasury and BC Stats. Where postal codes were not available or invalid, additional steps were taken to assign records to health regions using the census subdivision codes for place of residence recorded on the national death database.²

Corresponding Indicator(s) from Other Sources

Indicators for Chronic Disease Surveillance, Consensus of CSTE, NACDD, and CDC:

http://apps.nccd.cdc.gov/cdi/

• Crude counts, crude rates and age-standardized rates for all malignant cancers, lung and bronchus cancer, colon and rectum cancer, female breast cancer, cervical cancer, prostate cancer, melanoma, and cancer of the oral cavity and pharynx.
• Specific site codes: colon/rectum (ICD-10 C18-C20, C26.0), lung/bronchus (ICD-10 C34), female breast (ICD-10 C50), prostate (ICD-10 C61), cervix (ICD-10 C53), melanoma (ICD-10 C43), oral cavity & pharynx (ICD-10 C00-C14), all malignant cancers (ICD-10 C00-C97).

  
Data Sources

Numerator: Mortality Data
Original source: Ontario Office of Registrar General (ORG)
Distributed by:
1.  Cancer Care Ontario
2. intelliHEALTH Ontario, Ontario MOHLTC
Suggested citation (see Data Citation Notes):
1. Cancer Care Ontario (Ontario Cancer Registry), SEER*Stat Release [number] - OCRIS [date]
2. Ontario Mortality Data [years], intelliHEALTH Ontario, Date Extracted: [date], Ontario MOHLTC
 

Denominator: Population Estimates
Original source: Statistics Canada
Distributed by:
1. Cancer Care Ontario
2. intelliHEALTH Ontario, Ontario MOHLTC
Suggested citation (see Data Citation Notes):
1. Population Estimates [years]*, Cancer Care Ontario. SEER*Stat Release [number] - OCRIS [date]
1. Population Estimates [years]*, intelliHEALTH Ontario, Date Extracted: [date], 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 Sources

intelliHEALTH Ontario, Mortality file

ICD Codes*

*Source: Cancer Care Ontario (Ontario Cancer Registry), SEER*Stat 

Analysis Check List

• When using Cancer Care Ontario SEER*Stat data, suppress numbers <6 or rates or proportions based on counts less than 6. Null values are acceptable for release.
• When using Cancer Care Ontario's SEER*Stat data, be sure to read the accompanying documentation, particularly any document with details of issues concerning data and data quality.
• For intelliHEALTH Mortality data:
• 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 intelliHEALTH Population Estimate data:
• 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

Total Crude Death Rate:

total number of cancer-related deaths by ICD code total population

X 100,000

Age-specific Mortality Rate:

total number of cancer-related deaths by ICD code in an age group total population in that age group

X 100,000

SRATE (See Resources: Standardization of Rates):

Sum of (age-specific mortality rate in a given age group X 1991 Canadian population in that age group) Sum of 1991 Canadian population

X 100,000

SMR (See Resources: Standardization of Rates):

Sum of cancer-related deaths by ICD code in the population Sum of (Ontario age-specific rate X population in that age group)

Basic Categories

• Age groups for age-specific rates: 0-14, 15-29, 30-49, 50-64, 65-79, 80+ 
• Sex: male, female and total.
• Geographic areas of residence of deceased: public health unit, census division (CCO data not available at census-subdivision level except by special request to Cancer Care Ontario), LHIN, province.

Indicator Comments

• It is recommended that Cancer Care Ontario’s (CCO) cancer mortality be used as the source for cancer deaths when examining cancer mortality.  If the focus of analysis is total causes of mortality, of which one component may be cancer, it is recommended that intelliHEALTH be the source of data. 
• Cancer mortality data are available through Cancer Care Ontario on a SEER*Stat CD, which contains cancer data, population files and software for running queries on cancer registry data. The most current data release can be requested from http://www.cancercare.on.ca/english/toolbox/systeminfo/requestccodata/.  
• When compared with cancer mortality data from vital statistics (intelliHEALTH Ontario), there are slight discrepancies in the number of cancer deaths between the sources. These discrepancies may be due to differences in geographic coding, the timing of when the files were created as well as data manipulation by CCO related to site-specific cancer information.
• When comparing CCO cancer data to other Canadian cancer mortality data sources, users must be aware that ICD codes used for cancer sites can vary.  Discrepancies are highlighted in the document Comparisons - Differences in Canadian Cancer Incidence/Mortality definitions.
• When using Cancer Care Ontario’s SEER*Stat data, be sure to read the accompanying documentation, particularly any document with details of issues concerning data and data quality.
• Population data included with CCO’s SEER*Stat may differ slightly from population figures supplied by intelliHEALTH Ontario.
• ICD-10 codes used by CCO to categorize site specific cancers follow the Cause of Death Recode cancer definitions for mortality used by the U.S. National Cancer Institute’s Surveillance Epidemiology and End Results (SEER).³
• For comparability with Cancer Care Ontario, choose the cancer definitions in the "COD recode with Kaposi and mesothelioma”.
• Lung cancer is the leading cause of cancer mortality for both sexes in Canada.⁴
• Among men the cancer mortality rate for all cancers combined has been declining slowly since 1988, due to decreases in mortality rates for lung, colorectal, and certain other cancers.⁴
• However, among females, the lung cancer mortality rate has been increasing.  Thus, the ‘all cancer’ mortality rate, which has been relatively stable since 1980 conceals the almost 20% decline that has occurred for other types of cancer over this period.⁴
• 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.
• For additional information related to cancer data and its analysis, refer to the Resources section for a series of presentations:  Cancer Data and Analysis Resources.

Cross-References to Other Indicators

• All-cause mortality (Mortality, Morbidity and Health-Related Quality of Life - Section 3)

Cited References

• Public Health Agency of Canada. Cancer Surveillance On-line. Available online at: http://dsol-smed.phac-aspc.gc.ca/dsol-smed/cancer/index_e.html (Accessed May 15, 2009).
• Cancer, Smoking and Sun Safety Subgroup of Core Indicator. Comparisons - Differences in Canadian Cancer Incidence/Death definitions. Ontario: Association of Public Health Epidemiologists in Ontario, 2009.

Changes Made