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of public health epidemiology in Ontario

Neonatal and Infant Mortality Rates Core Indicator

  • The ratio of the number of deaths of live born infants during a calendar year per 1,000 live births in the same calendar year. 
Report an IssueAppendices

Related OPHS Topics

Reproductive Outcomes
 

Method of Calculation

 
Infant Mortality Rate
Total number of deaths for live born infants (364 days or younger)
1000
Total number of live births
1000
 
Neonatal Mortality Rate
Total number of deaths for live born infants (27 days or younger)
1000
Total number of live births
1000
 
Post-Neonatal Mortality Rate
Total number of deaths for live born infants (28-364 days)
1000
Total number of live births
1000

Recommended Subset Analyses

Age of Mother
  • [Enter Categories Here]
Gestational Age
  • [Enter Categories Here]
Birth Weight
  • [Enter Categories Here]
 Sex of Infant 
  • [Enter Categories Here]
Age of Infant
  • Early Neonatal: 0-6 days
  • Late Neonatal: 7-27 days
  • Post-Neonatal: 28-364 days
Geographic areas of patient residence
  • Ontario
  • Public Health Unit
  • Municipality
  • Smaller areas of geography based on aggregated postal code


Data Sources

Numerator
Denominator 
Alternative Data Source(s)
Vital Statistics Mortality Data

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].
Vital Statistics Live Birth Data

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 Live Birth Data [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].
None
 
Neonatal Death ICD Codes

Classification

ICD-10-CA

ICD-9

All causes

  

  

All accidental deaths

V01-Z99

E800-E999

Homicide/infanticide

X85-Y09

E960-E969

Shaken Baby Syndrome

S06 with Y07

850-854 with E967

Child battery and maltreatment or criminal neglect

Y06-Y07

E967 & E968.4

Falls

W00-W19

E880-E888

RDS: Respiratory Distress Syndrome

P22

769.0-769.9

SIDS: Sudden Infant Death Syndrome

R95

798.0

Congenital anomalies

Q00-Q99

740-759

Low birth weight (not short gestation)

P05

764

Low birth weight with short gestation

P07

765

Intrauterine hypoxia and birth asphyxia

P20 & P21

768

Other conditions of the perinatal period

P00-P04, P08, & P23-P96

760-764, 766, & 770-779

Pneumonia and influenza

J10-J18

480-487

Certain gastrointestinal diseases

A00-A09, K29, K50-K52, K55-K63

008-009, 535, & 555-558




 

Analysis Checklist  

General Checklist
  • 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.
  • Analyze by infant residence, not place of death. 
  • Some authors suggest a denominator of 10,000 or more to obtain accurate estimates of mortality.
  • Small numbers of events may require the suppression of information, collapsing several years of data, or the use of smoothing techniques to eliminate large variations in reported rates.
  • HELPS Data: Historically, PHUs obtained data for live births, stillbirths, therapeutic abortions, congenital anomalies, and 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.

Vital Statistics - 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. Include other items, depending on your requirements (ICD10 Chapter, Lead Cause Group, age group, sex, etc.).
  • 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.

Vital Statistics - Live Birth Data
  • In IntelliHEALTH under Standard Reports, folder "01 Vital Stats", open " Birth Summary V2". This report summarizes information on births by age group and mother's residence (Ontario, PHU and LHIN). IntelliHEALTH also provides population data (total population, female population aged 15-49 years) for the calculation of rates. Refer to the Notes tab for information. Open tab "1.2 Births x PHU x Type x Age" to obtain public health unit data and tab "1.1 ON Births x Type x Age" to obtain Ontario data. The report can be modified, renamed and saved under your own folder or can be exported into Excel. 
  • The predefined report provides live birth and population data for the calendar years from 2000 to the most recent available. Table options can be edited to change the number of years of data presented. For years that are not displayed modify the calendar year filter to include the required years.
  • The data contained in the Birth Summary V2 report includes birth to Ontario mothers in Ontario only.
  • The notes section of the report provides important data caveats and background information on data sources and should be consulted.

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Indicator Comments

General Comments
  • Infant mortality rates are considered an indicator of social and economic conditions within a country, community or subpopulation (2, 3). High rates may reflect inadequate nutrition, low levels of education, exposure to environmental hazards, limited utilization of or access to adequate health care services (3).
  • Infant mortality rates may vary by country due to the definition of a live birth.
  • Disparities in the risk of infant death across subpopulations have been reported previously in Canada (including aboriginal populations) (4, 5).
  • In 1999, congenital anomalies were the leading cause of infant death in Canada; however immaturity became the leading cause of infant death in 2004. Immaturity was the leading cause of neonatal death, and congenital anomalies was the leading cause of post-neonatal death in Canada in 2004 (1).
  • Determining the true cause of death is not always clear resulting in somewhat subjective primary cause of death being listed on death certificate. The reported cause of death may also be influenced by the social or legal conditions surrounding the death and by the level of medical investigation.
  • Registration fees initiated in some CSDs in 1996 may have reduced the number of infants registered, especially for low income and/or adolescent parents (6); however it is worth noting that registration fees have since been discontinued in Ontario. Please refer to the Timeline of changes in Live Birth Registration in Ontario document for details.
  • In all provinces except Ontario, Statistics Canada linkages of live birth and infant death registration are successful for all but 1.1% of cases (2003); in Ontario 42.3% were unlinked (1). The unlinked cases vary from linked cases by time of death and cause of death (1). This linkage issue precludes the reliable calculation certain figures, such as gestational age-specific infant mortality rates.
  • Infant mortality rates are higher among multiple births (8) and births to mothers over 35 (9). Changing pattern of registration of live births with a birth weight less than 500 grams in Canada has shown to have significantly increased infant mortality rates as such infants have very high rates of mortality (10).
  • It is recommended to exclude births weighing <500 g from neonatal and infant mortality rates. Doing so may reduce fluctuations in estimates and facilitate comparisons across jurisdictions. However, it is not possible to examine neonatal and infant mortality among births ≥500 g due to data limitations in Ontario. Please refer to the Reproductive Health Core Indicators Documentation Report for recommendations on excluding live births <500 g from reproductive health indicators.
  • Given the small number of stillbirths/perinatal/infant deaths, stillbirth rate, perinatal/infant mortality rates may fluctuate from year to year. It may be of beneficial to group years when reporting stillbirth rate/perinatal mortality/infant mortality and/or calculate a three-year moving average (Refer to Document: Methods for Calculating Moving Averages).
  • ICD code groupings provided in the Canadian Perinatal Health Report (appendix A.2) may be useful if choosing to examine infant mortality by cause (1).
  • Neither BORN nor Hospitalization birth records can be linked to vital statistics mortality data at this time. Therefore, BORN and Hospitalization data sources cannot be used to determine neonatal or infant mortality.
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References

Glossary

Live birth - the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life such as heartbeat, umbilical cord pulsation, or definite movement of voluntary muscles, whether the umbilical cord has been cut or the placenta is attached. A live birth is not necessarily a viable birth.

Infant mortality - death of a live born infant before the 365th day of life.

    Mortality rates - based on deaths during the following specified periods:
  • Infancy (infant) - the period between a live birth and 364 days of life. 
  • Late neonatal - the period between the 7th and 27th day of life.
  • Neonatal - the period life between a live birth and the 27th day of life.
  • Post-neonatal - the death of a live born infant between the 28th and 364th day of life.

Sudden infant death syndrome (SIDS) - the unexpected and sudden death of an apparently healthy infant. It is more often reported in infants between two weeks and one year of age, in preterm infants, and males. Also called crib death. ICD-9 code: 798.0. Note that some researchers use ICD-9 codes: 798.0-798.9.

Respiratory distress syndrome (RDS) - a respiratory disorder that occurs in newborn premature infants and is characterized by deficiency of the surfactant coating the inner surface of the lungs, failure of the lungs to expand and contract properly during breathing resulting in collapse; and by the accumulation of a protein-containing film lining the alveoli and their ducts. Also called hyaline membrane disease;

Congenital anomaly - a condition that results from an abnormality of structure, function or metabolism in one or more parts of the body, with potential to adversely affect health, development or function. Anomalies are present at birth and may be inherited genetically, acquired during gestation, or inflicted during birth. Also called a birth defect.

Intrauterine Hypoxia (IH) - occurs when the fetus is deprived of an adequate supply of oxygen. IH is used to describe inadequate oxygen availability during the gestation period.

Birth asphyxia - (also refered to as perinatal asphyxia or Asphyxia neonatorum ) can result from inadequate supply of oxygen immediately prior to, during or just after delivery.


Components of Fetal-Infant Mortality

Cited References
  1. Public Health Agency of Canada. Canadian Perinatal Health Report. 2008 Edition. Ottawa, 2008. Available from:  http://www.phac-aspc.gc.ca/publicat/2008/cphr-rspc/pdf/cphr-rspc08-eng.pdf
  2. World Health Organization. Neonatal and perinatal mortality: Country, regional, global estimates. Geneva, 2006. Available from: http://whqlibdoc.who.int/publications/2006/9241563206_eng.pdf
  3. Spong, CY, Iams, J, Goldenberg, R. Hauck, FR, Willinger, M. Disparities in perinatal medicine. Obstet Gynecol. 2011;117(4):948-955.
  4. Kleinman JC. The slowdown in the infant mortality decline. Paediatric Perinatal Epidemiology. 1990; 4(4):373-381.
  5. Luo ZC, Senecal S, Simonet F, Guimond E, Penney C, Wilkins, R. Birth outcomes in the Inuit-inhabited areas of Canada. Canadian Medical Association Journal 2010, 182(3): 235-42
  6. Bienefeld M, Woodward GL, Ardal S. Underreporting of live births in Ontario: 1991-1997. Central East Health Information Partnership, February 2001.
  7. Woodward GL, Ardal S. Data Quality Report: Effect of Residence Code Errors on Fertility Rates. Central East Health Information Partnership, July 2000.
  8. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2007 period linked birth/infant death data set. National Vital Statistics Report (US). 2011 June 29; 59(6):1-31.
  9. Gage TB, Fang F, O'Neill E, Stratton H. Maternal age and infant mortality: a test of the Wilcox-Russell hypothesis. American Journal of Epidemiology 2009; 169(3):294-303.
  10. Joseph KS, Kramer MS. Recent trends in Canadian infant mortality rates: the effect of changes in registration of live newborns weighing less than 500g. Can Med Assoc J 1996; 155(4):1047-52.


Acknowledgements

Lead Authors

Jessica Deming, Region of Waterloo Public Health

Sandy Dupuis, Niagara Region Public Health

Natalie Greenidge, Public Health Ontario

Reviewers

Ahalya Mahendra, Public Health Agency of Canada (Core Indicators Work Group Member)

Carmen Yue, Toronto Public Health

Contributing Authors

Reproductive Health Sub-group

 

Revision History

 This Core Indicator Product webpage is maintained by the Reproductive Health Subgroup.  
Date Review Type Author Changes PDF
May 30, 2005        
  • Indicator Created
March 29, 2012 - January 16, 2013 Formal Review  Reproductive Health Sub-Group
  • All sections updated in alignment with the Guide to Creating or Editing Core Indicator pages
  • Significant changes made to many aspects of indicator, including: Specific Indicators, Corresponding Indicators from Other Sources, Data Sources, Method of Calculation, Definitions, Indicator Comments, Cited References, Other References.
  
September 18, 2019 
Website Update:
No Content Review  
Caitlyn Paget, 
on behalf of the CIWG 
    No changes made to indicator definitions.
    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.  
  • Renamed "Basic Categories" section to "Recommended Subset Analysis Categories"; "Definitions" renamed to "Glossary".  
  • 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.
  

 

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Please contact core.indicators@apheo.ca for further information.  
   
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