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of public health epidemiology in Ontario

Injury-Related Mortality Core Indicator

Number of deaths due to injury.

 

Method of Calculation 

Crude Mortality Rate for Injury
Total number of injury-related deaths: defined by ICD codes
100,000
Total population
100,000

Age-specific Mortality Rates
Total number of deaths in an age group
100,000
Total population in that age group

Age groups outlined in Recommended Analysis Categories section below
100,000

Age-standardized Rate (SRATE)
Sum of (age-specific rate x 
standard population in that age group),
 for all age groups
100,000

See Standardization of Rates Resource for more information on direct standardization
100,000

 
Standardized Mortality Ratio (SMR)
Total number of deaths in the population
100
Sum of (Ontario age-specific rate x population in that age group), for all age groups

See Standardization of Rates Resource for more information on indirect standardization
100

Recommended Analysis Categories

Suggested Age Groups
      IntelliHEALTH Chronic Disease age groups
      - Age Group (CD):
  • <1-19 years
  • 20-44 years
  • 45-64
  • 65-74
  • 75+
  •   IntelliHEALTH Infant + 5-yr age groups
      - (inf,5yr):
  • <1
  • 1-4
  • then 5 yr groups to 90+
Potential Age Groups for Specific Analysis Questions
  • 0-4: groups ages <1 and 1-4
  • Youth: ages 15-24, a common category for analyzing self-harm data 
  • Seniors/Older adults: ages "65+"
Sex
  • Male
  • Female
  • Total
Geographic areas of residence
  • Ontario
  • Public Health Unit
  • Municipality
  • Smaller areas of geography based on aggregated postal code.
Injury Intention
  • Unintentional
  • Intentional
 

Data Sources

Numerator Denominator Alternative Data Source

Original Source:

Vital Statistics, Office of Registrar General (ORG), Service Ontario

Distributed by:

Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH Ontario (IntelliHEALTH)

Suggested Citation:

Ontario Mortality Data [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].

Original Source:

Statistics Canada

Distributed by:

Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)

Suggested Citation:

Population Estimates [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].

Original Source:

Canadian Institute for Health Information (CIHI)

Distributed by:

Canadian Institute for Health Information (CIHI)

Suggested Citation:

Ontario Trauma Registry [month, year – month, year], Extracted: [month,year].


ICD Codes: Leading Causes of Injury Mortality for unintentional and intentional injuries

Please refer to the Recommended ICD10-CA codes for Injury Core Indicators resource for detailed discussion on injury classification.  

Classification

ICD-10-CA

ICD-9

Drowning/submersion

W65-W74, V90, V92

E830, E832, E910

Falls

W00-W19

E880-E888

Land Transport

V01-V89

E800-E829, E846-E848

Unintentional Poisoning

X40-X49

E850-E869

Suffocation and Foreign Body

W44, W45, W75-W84

E911-E915

Unintentional Firearm Discharge

W32-W34

E922  

Self-harm

X60-X84, Y87.0

E950-E959

Assault

X85-Y09, Y87.1

E960-E969

Other Unintentional Injuries*

*ICD10 external cause of injury codes that are of undetermined intent, legal intervention and operations of war, and complications of medical and surgical care are not included in these leading cause categories. These codes are not included in the definitions of unintentional or intentional injury according the International External Cause of Injury Matrix (3-5).

V91, V93-V99, W20-W43, W46-W64, W85-W99, X00-X39, X50-X59, Y85-86

 

E831, E833-E839, E840-E845, E900-E909, E918, E919, E921, E923, E925-E926, E928, E929 




 
 
  

Analysis Checklist  

General Checklist
  • Registered IntelliHEALTH users can find a predefined report called 'Mortality - Ext Cause of Injury - PHU Indicator List'- in the APHEO Public Health Indicators folder in the Standard Reports section under Team Content.
  • Please follow the Analysis Checklist for the Vital Statistics: Mortality data source.  
  • 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.
      • Please see the Standardization of Rates methodology resource page for analytic recommendations and sample calculations.  

Classifying Injuries
  • Given the complexities in classifying injuries (most responsible diagnosis codes, external cause of injury codes, nature of injury codes) as well as the fact that for there are instances when one person can have multiple injury diagnosis codes, a resource document was written that provides more detail and recommendations. Please refer to the resource document for a further discussion: Recommended ICD10-CA codes for Injury Core Indicators.
  • The ICD10 code tables in the resource document provide recommendations for categories that can be reported, however health units may choose to add categories or merge categories due to small numbers depending on the specific analysis questions.
  • The ICD10 code categories for mortality are mutually exclusive of one another.    
  • 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 specified.
  • The Injury Core Indicators Stata syntax file is available to support analysts in their variable definition.  

Indicator Comments

Injury-related Mortality
  • 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.
  • 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.

Attributing Causes of Mortality
  • The ICD code categorization is adapted from Leading Cause Groups for Mortality Tabulation found in the All-Cause Mortality Core Indicator, which is based on Becker's et al. leading causes of death of categories (5).
  • 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 (3, 4).
  • 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.


  

References

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: http://www.statcan.gc.ca/pub/82-624-x/2011001/article/11506-eng.pdf.
  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: https://www150.statcan.gc.ca/n1/pub/84-215-x/2011001/table-tableau/tbl003-eng.htm.
  3. 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: http://dsol-smed.phac-aspc.gc.ca/dsol-smed/is-sb/index-eng.php.
  4. 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: http://www.cdc.gov/nchs/injury/injury_matrices.htm  Matrix File: http://www.cdc.gov/nchs/data/ice/icd10_transcode.pdf  User friendly Matrix file: http://www4.state.nj.us/dhss-shad/query/InjuryMatrix.html.
  5. 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: http://www.who.int/bulletin/volumes/84/4/297.pdf.

Acknowledgements

Lead Authors

Suzanne Fegan, KFL&A Public Health (Subgroup Lead)

Michelle Policarpio, Public Health Ontario

Reviewers

Hilary Blackett, North Simcoe Muskoka LHIN

Contributing Authors

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

  


Revision History

 This Core Indicator Product webpage is maintained by the Injury Prevention Subgroup.
Date Review Type Author Changes PDF
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 Ad hoc   
March 2009 Ad hoc   
  • 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).

November 2, 2019 
Website Update
and Ad Hoc Review
Suzanne Fegan,
on behalf of the Injury Prevention subgroup;
Caitlyn Paget, 
on behalf of the CIWG 
    Updated indicator definitions and documentation: 
  • Added Injury Intention as a subset analysis category.  
  • Revised the analysis checklist to remove out-of-date instructions for previous IntelliHEALTH platform, and move duplicate content to the appropriate Data Source page. 
  • Improved cross-references to supporting resources. 
  • Minor edits to content wording.    
  • Migrated to new website structure and format, including:
  • Reorganized content to provide high-level information at a glance, and move in-depth analytic information into dedicated sections for users to access when needed.
  • Generalized formulas for Age-Specific Rates, SRATE, and SMR.
  • Renamed "Basic Categories" to "Recommended Subset Analysis Categories"; "Definitions" renamed to "Glossary".
  • Added Ontario Trauma Registry reference information to the data source table.
  • Replaced both "Cross-References to Other Indicators" and "OPHS" sections with "Related OPHS Topics" to crosslink with relevant Core Indicators webpages including OPHS program standard(s) and associated indicator(s).
  • Added descriptive sub-headings to the Analysis Checklist and Indicator Comments sections.
  • Removed "Corresponding Health Indicator(s) from Statistics Canada and CIHI" and "from Other Sources" sections.
  • Updated Revision History table, and added PDF copy of previous version for reference.


 

APHEO's Core Indicators Project has been developed through collaboration across the field of public health in Ontario, 
to provide standardized methodology for population health assessment, to measure complex concepts of individual and community health.
Please contact core.indicators@apheo.ca for further information.