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4C Injury-Related Mortality

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


  • Crude mortality rate for injury - the total number of deaths from selected causes of injury relative to the total population during a given year (fiscal or calendar) (usually expressed per 100,000).
  • Age-specific mortality rates for injury - the annual number of deaths in a given age group from selected causes of injury per the population in that age group during a given year (fiscal or calendar) (usually expressed per 100,000).
  • Age-standardized mortality rates (SRATEs) for injury - the number of deaths from selected causes of injury per 100,000 population that would occur if the population had the same age distribution as the 1991 Canadian population.
  • Standardized mortality ratio (SMRs) for injury - the ratio of observed deaths for selected injuries 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) for specific unintentional injury (e.g., injury due to all causes, burns, falls, poisoning etc.)
Ontario Public Health Standards 
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. 

Outcomes Related to this Indicator
  • Board of Health Outcome (Prevention of Injury and Substance Misuse): The board of health is aware of and uses epidemiology to influence the development of healthy public policy and its programs and services for the prevention of injury and substance misuse.
  • Board of Health Outcome (Foundational Standard): The public, community partners and health care providers are aware of relevant and current population health information.
Assessment and Surveillance Requirements Related to this Indicator (Prevention of Injury and Substance Misuse)
  • The board of health shall conduct epidemiological analysis of surveillance data in the areas of injury and substance misuse outcomes. 

Corresponding Health Indicator(s) from Statistics Canada and CIHI 
  • Age-Standardized Injury Hospitalization Rate (per 100 000) 

Corresponding Indicator(s) from Other Sources
  • None
Data Sources (see Resources: Data Sources) 

Mortality Data
Original source: Vital Statistics, Ontario Office of Registrar General (ORG), ServiceOntario
Distributed by: Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)
Suggested citation (see Data Citation Notes): Death [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 (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)
Suggested citation (see Data Citation Notes): Population Estimates [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].


Alternative Data Source
  • Ontario Trauma Registry
ICD Codes 
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.
  • IntelliHEALTH Ontario is developing a complete set of pre-defined reports for injury-related Core Indicators, (i.e., templates that permit standardized queries by local public health agencies). Registered IntelliHEALTH users can find a predefined report called 'Mortality - Injury External Causes- indicator data list' in the APHEO Public Health Indicators folder in the Standard Reports section.
  • For IntelliHEALTH:
    • Use Deaths data source from the Vital Statistics folder in IntelliHEALTH, select # Dths (ON res) measure (number of deaths for Ontario residents who died in Ontario). Note that 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 (ICD-10 Chapter, Lead Cause Group, age group, year, 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 (ICD-10  V-Y; ICD9 E-Codes), and not Injury & Poisoning Codes (ICD-10-CA 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 ICD-10 codes (S-T) are not available for the years that ICD-10 codes are used (beginning in 2000).  
    • Please note that the Mortality dataset uses ICD-10 codes which can have a maximum length of 4 digits, instead of ICD-10-CA codes which can be up to 5 digits long. 
    • 'Place of occurrence' may also be used for codes W00-Y34 to identify place of external cause. Please note that there may be a large number of cases where place of occurrence is missing or not specfied.
  • HELPS Data: Historically, PHUs obtained data for deaths from the Ministry of Health through HELPS (the HEalthPlanning System). Although these data are no longer commonly used, some PHUs may still be accessing these data files. Information about the data can be found in the HELPS Data Source resource.
Method of Calculation

Crude Rate

total number of injury-related deaths by ICD code

    x 100,000

total population

Age-specfic Rate

total number of injury-related deaths in an age group by ICD code 

    x 100,000

total population in that age group 


SRATE (See Resources: Standardization of Rates)

sum of (injury-related deaths in a given age group x 1991 Canadian population in that age group)

    x 100,000

sum of 1991 Canadian population

SMR (See Resources: Standardization of Rates)

sum of injury-related deaths in the population

    x 100

sum of (Ontario age-specific rate x population in that age group)

Basic Categories
  • Suggested Age Groups:
    • <1-19 yr, 20-44, 45-64, 65-74, 75+. (IntelliHEALTH Chronic Disease age groups -Age Group (CD)) or
    • <1, 1-4, then 5 yr groups to 90+. (IntelliHEALTH Infant + 5-yr age groups - (inf,5yr))
      *Note: Health units may choose to merge age categories due to small numbers, or change age categories depending on the specific analysis questions.  Examples of other potential age categories include:
      • '<1, 1-4 could be changed to "0-4"
      • ‘Youth' could be analyzed as '15-24', a common category for analyzing self-harm data 
      • ‘Seniors/Older adults' could be analyzed as ages "65+"
  • Sex: male, female and total
  • Geographic areas of residence: Ontario, public health unit, municipality, and smaller areas of geography based on aggregated postal code.

Indicator Comments

  • In Canada, 15,064 people died of injury-related causes (6% of all fatalities) in 2007 (1). Of these deaths, 24% were suicides, 21% were transport-related deaths, 18% were the result of a fall, 9% were due to poisoning, and 3% were homicides (1).
  • Injury is the leading cause of death in Canada for people aged 1 to 34 (2).
  • Across all age groups, unintentional injury ranks fourth among the leading causes of death, after cancer, circulatory system and respiratory diseases (3).
  • 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.  
  • The grouping of unintentional injury codes excludes codes for "misadventures to patients during surgical and medical care" (Y40-Y84). This coding matches that used for the National Indicators (4, 5).
  • 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.
  • 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.
  • 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.
  • Leading Cause Groups for Mortality (6), APHEO 
  • Injuries can be categorized as unintentional (i.e. accidental) and intentional (i.e. deliberate) (6).

Cross-References to Other Indicators

Cited References
  1. Billette JM, Jans T. Injuries in Canada: insights from the Canadian Community Health Survey. Health at a Glance Statistics Canada Catalogue no. 82-624-X. Ottawa, ON: Her Majesty the Queen in
    Right of Canada; 2011 [cited 2012 Jul 10]. Available from:
  2. Statistics Canada [homepage on the Internet]. Ottawa: Statistics Canada; 2011 Nov 1 [cited 2012 Jul 10]. Leading causes of death in Canada, 2008. Available from:
  3. Ministry of Health and Long-Term Care. Chief Medical Officer of Health Report Injury: predictable and preventable. Toronto, ON: Queen's Printer for Ontario; 2002 [cited 2012 Jul 10]. Available from:
  4. Public Health Agency of Canada [homepage in the Internet]. Ottawa: Public Health Agency of Canada; 2010 Feb 1 [2012 Jul 10]. Injury Surveillance On-line. Available from:
  5. Centers for Disease Control and Prevention [homepage on the Internet]. Atlanta: Centers for Disease Control and Prevention; 2009 Nov 25 [cited 2012 Jul 10].  ICD 10 injury matrices. Available from:  Matrix File:  User friendly Matrix file:
  6. Becker R, Silvi J, Ma Fat D, L'Hours J, Laurenti R. A method for deriving leading causes of death. WHO Bulletin. 2006 [cited 2012 Jul 10];84(4):297-303, Appendices A-D. Available from:
Other References
  1. Macpherson AK, Schull MJ, Manuel D, Cernat C, Redelmeier DA, Laupacis A. Injuries in Ontario: ICES Atlas. Toronto, ON: Institute for Clinical Evaluative Sciences; 2005 [cited 2012 Jul 9]. Chapter 1, General Description of Injuries in Ontario. 2002-2003; p. 1-22. Available from:
  2. SMARTRISK. The economic burden of injury in Canada. Toronto: SMARTRISK; 2009 [cited 2012 Jul 9]. Available from:
  3. Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Fazlur Rahman AKM et al, editors. World report on child injury and prevention. Geneva: World Health Organization, 2008 [cited 2012 Jul 9]. Available from:
Changes Made


Type of Review (Formal Review or Ad Hoc?)

Changes made by


July 16, 2012

Formal review

Injury and substance misuse prevention sub-group

  • New section on OPHS added
  • Data source information updated to reflect use of IntelliHEALTH Ontario
  • Updated analysis check-list, indicator comments, definitions, cited references and other references.

July 2009



March 2009



  • Updated ICD-10 codes for Motor Vehicle Traffic Crashes based on the matrix that the International Collaborative Effort on Injury Statistics has put together and posted on the US National Center for Health Statistics website. Changed title back from Motor Vehicle Crashes (title was changed in 2008).

Lead Author(s)

  • Suzanne Fegan, KFL&A Public Health (Subgroup Lead)
  • Michelle Policarpio, Public Health Ontario

Contributing Author(s)

  • Injury and Substance Misuse Prevention Subgroup
    • Christina Bradley, Niagara Region Public Health
    • Badal Dhar, Public Health Ontario
    • Jeremy Herring, Public Health Ontario
    • Natalie Greenidge, Public Health Ontario
    • Sean Marshall, Public Health Ontario
    • Jayne Morrish, Parachute
    • Lee-Ann Nalezyty, Northwestern Health Unit
    • Narhari Timilshina, Toronto General Hospital


  • Hilary Blackett, North Simcoe Muskoka LHIN
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