Vital Statistics Mortality Data

The Office of the Registrar General (ORG) obtains information about mortality from death certificates which are completed by physicians. All deaths within Ontario are registered in the office of the division registrar within which the death occurs. The ORG provides death data to Statistics Canada for national reporting.

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

See Data Citation Notes.

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Related OPHS Standards

Chronic Disease Prevention and Well-Being Healthy Growth and Development Immunization Infectious and Communicable Diseases Prevention and Control Substance Use and Injury Prevention

Data Notes

Background

The Office of the Registrar General (ORG), ServiceOntario, obtains information about mortality from death certificates which are completed by physicians. All deaths within Ontario are registered in the office of the division registrar within which the death occurs. A Statement of Death (Form 15) and a Medical Certificate of Death (Form 16) must be filed with a division registrar before a Burial Permit can be issued.
The ORG provides death registration data to Statistics Canada for national reporting. With the ORG's approval, Statistics Canada provides the Ministry of Health and Long Term Care with an edited and standardized dataset for deaths that occurred in Ontario, which is uploaded to IntelliHEALTH (1).
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 reports may still reference these data files. Information about the data can be found in the HELPS Data Source page.

Cause of Death

The Death Certificate records the immediate cause of death; antecedent causes, if any, giving rise to the immediate cause, stating the underlying cause last; and other significant conditions contributing to the death but not causally related to the immediate cause (2). However, Vital Statistics mortality data available through IntelliHEALTH include only the primary (i.e. underlying) cause of death. The underlying cause of death is (a) the disease or injury which initiated the chain of events leading directly to death, or (b) the circumstances of the accident or violence which produced the fatal injury (3).
Co-morbidity contributes uncertainty to classifying the underlying cause of death.
Determining true cause of death may also be influenced by the social or legal conditions surrounding the death and by the level of medical investigation (e.g. AIDS, suicide).
The Ninth Revision of the International Classification of Diseases (ICD-9) (3) was used to code cause of death from 1979 until 1999 (Note: data is only available in IntelliHEALTH from 1986 onwards). From 2000 onward causes of death were coded using the Tenth Revision of the International Classification of Diseases (ICD-10). Comparison of trends for specific causes of death from 2000 onward with earlier rates must therefore be interpreted with caution. See Statistics Canada's report "Comparability of ICD-10 and ICD-9 for Mortality" for more information (4).
For a discussion of data quality concerns surrounding classification of stillbirths, please refer to Vital Statistics Stillbirths Data Source page.
Counts of deaths by ICD-9 chapter in the 1997 Ontario Mortality Database differ from those found in the Ontario Registrar General's Annual Report. The differences relate to the date on which Statistics Canada created their "final mortality data file". At that time, all deaths for which the cause was not yet officially established were coded as 799 (Other ill-defined and unknown causes of morbidity and mortality). The ICD-9 Chapter associated with this code is therefore over-represented when compared to previous years of data while Chapters XVI, VII, II and Supplementary Classifications of External Causes of Injury & Poisonings may be under-reported.

Place of Death and Residence of the Deceased Locations

IntelliHEALTH mortality data includes Ontario residents who died within the province as well as non-Ontario residents who died in Ontario (1). In order to exclude deaths of non-Ontario residents, in the ‘Deaths data source' from the Vital Statistics folder in IntelliHEALTH, select ‘# ON Deaths measure (number of deaths for Ontario residents who died in Ontario)'.
There are possible errors in the mortality data file related to assignment of municipality of residence/census subdivision of deceased. The Central East Health Information Partnership (CEHIP) completed a report on this issue for the live birth file in July, 2000 (5).
Prior to 2008, county, municipality, and PHU geographic locations in IntelliHEALTH for place of occurrence and place of residence of mother were derived from a municipality code supplied by ORG to Statistics Canada. LHIN was derived from municipality where possible and from postal code when the municipality was shared by several LHINs. From 2008, the place of occurrence municipality coding was discontinued by Statistics Canada and only postal code for residence was maintained. Statistics Canada now derives the municipality of residence from the postal code using the Postal Code Conversion File Plus (PCCF+) programs where there is a valid postal code. If no valid postal code is available, manual coding of residence municipality is done from any available address information on the record. Statistics Canada still uses special codes to indicate Indian Reserves within a county when a specific reserve is not identified on the registration.

Analysis Checklist

General Checklist for All Associated Indicators

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.
Variation in data collection procedures over time and/or geography may reduce the validity of time and/or place-specific comparisons
ICD-10 has a greater level of specificity and different code titles than ICD-9; forward conversion is not recommended. Refer to the Core Indicators' International Classification of Diseases, 10th Revision (ICD-10) resource for more information.

Associated Indicators

Injury-Related Mortality

References

Cited References

Ontario Ministry of Health and Long-Term Care. The Health Analyst's Toolkit. Health Analytics Branch, 2012. Available at: http://www.health.gov.on.ca/english/providers/pub/healthanalytics/health_toolkit/health_toolkit.pdf
Office of the Registrar General. Medical Certificate of Death, Form 16.
World Health Organization. International Classification of Diseases, 1975 Revision, Volume 1, Geneva: World Health Organization, 1977.

Statistics Canada. Comparability of ICD-10 and ICD-9 for Mortality Statistics in Canada. Ottawa: Ministry of Industry, 2005. Catalogue no. 84-548-XIE. Available at: http://www5.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=84-548-X&chropg=1&lang=eng
Woodward GL, Ardal S. Data Quality Report: Effect of Residence Code Errors on Fertility Rates. Central East health Information Partnership (CEHIP), 2000. Available at: https://www.apheo.ca/resources/indicators/Birth%20Geocoding%20Report%20Final%20for%20Website.pdf

General References

Woodward GL, Delmore T, Fehringer G, Goettler F, Guarda B, McGurran JJ, Pietrusiak M. Questioning one of life's certainties: A comparison of three mortality data sets. Central East Health Information Partnership (CEHIP), 1999. Available at: https://www.apheo.ca/resources/indicators/Birth%20Geocoding%20Report%20Final%20for%20Website.pdf

Acknowledgements

Lead Authors

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

Contributing Authors

Injury and Substance Misuse Prevention Work Group:

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

Michelle Policarpio, Public Health Ontario

Narhari Timilshina, Toronto General Hospital

Reviewers

Anne Marie Holt, HKPR District Health Unit

Revision History

This Core Indicator Product webpage is maintained by the Health Outcomes Subgroup.

Date	Review Type	Author	Changes	PDF
October 31, 2012	Formal Review	Suzanne Fegan	Added details about information available through IntelliHEALTH.
October 2, 2019	Website Update: No Content Review	Caitlyn Paget, on behalf of the CIWG	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. Added short data source description in header. Moved data-specific Analysis Checklist items from the indicator pages to reduce duplication. Crosslinked to relevant Core Indicators webpages including OPHS program standard(s) and associated indicator(s). Added Revision History table, with 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.