MHLU - Health Status Resource

Death From All Causes

Death From All Causes

Key Findings: 

Patterns in all-cause mortality highlight long-term changes in the population’s health.1 Public health programs and services, along with the health care system, influence overall population health outcomes including the reduction in avoidable deaths that can be prevented or treated.2

Major changes in the death rate took place in Middlesex-London and Ontario overall in the decade from 2006 to 2015. Population growth and aging resulted in an increase in the absolute number (or crude) number of deaths recorded year-over-year from 3,082 total deaths in 2006 to 3,681 deaths in 2015. After accounting for population size and age structure, age-standardized mortality rates significantly decreased, indicating overall improvements in Middlesex-London over the decade from 2006 to 2015.

Despite overall improvements in the past decade, the all-cause, age-standardized mortality rate flattened from 2013 through 2015 in Middlesex-London. This contrasts with the continued improvement in Ontario beyond 2010.

Death counts Sub-group differences in death from all causes
Time trends in deaths from all causes  

Death counts

The average number of deaths for residents of Middlesex-London from all causes was 3,571 per year for the three-year period from 2013–2015. There were slightly more deaths in females (1,801) than in males (1,770) each year (Figure 3.3.1).

The number of deaths steadily increased in the past decade from 3,082 in 2006 to 3,681 in 2015 for residents of Middlesex-London, with a minor decline in 2011 (Figure 3.3.1).

The average rate of deaths for residents of Middlesex-London was 767.3 per 100,000 for the three-year period from 2013–2015. The rate was slightly higher in males (794.1/100,000) than in females (774.6/100,000) (Figure 3.3.1).

All-cause mortality increased with age for both females and males and substantially increased in the 85+ age group from the rates found in the 75 to 84 age group (Figure 3.3.2).

When age and gender specific rates were considered, females had a significantly lower rate than males within each age group (Figure 3.3.2).

Interpretation
Death counts and crude rates provide a picture of the number of deaths in the population and the actual changes in the death rate over time. Apart from underlying changes in health status, an increase in the total number of deaths is largely attributable to two factors: a growing population and an aging population. A small increase in the death count each year, comprised of more females than males, is consistent with changes in the population structure of Middlesex-London. Despite more females dying each year in the past decade, the age and gender specific rates indicate that females are actually doing better than males within each age group in all-cause mortality rates.

Time trends in deaths from all causes

When the population increases and aging of the population are accounted for, there was an overall decline in the mortality rate for Middlesex-London residents in the decade from 2006 to 2015 (Figure 3.3.3).

When the pattern was examined more closely, there was a significant decrease in the age-standardized mortality rate from 2010 to 2011 in Middlesex-London. However, in 2012 the trend reversed and there was a subsequent increase in 2012 and a flattening out of the rate from 2013 –2015 (Figure 3.3.3).

This more recent increase and flattening of the rate in Middlesex-London was in contrast with Ontario’s trend overall which continued to steadily decline beyond 2010. Middlesex-London’s rate was higher in 2013 than Ontario’s rate overall and it continued to be significantly higher in 2014 and 2015. By 2015, Middlesex-London’s all-cause age standardization rate (697.8/100,000) was substantially higher than Ontario’s overall (642.8/100,000) and was similar to rates found in Ontario five years earlier (Figure 3.3.3).

Females consistently had a significantly lower all-cause age-standardized mortality rate than males in Middlesex-London over the decade spanning 2006 to 2015 and the decrease from in the rate for females from 643.6/100,000 in 2006 to 582.1/ 100,000 in 2015 was also a significant decline over time. There was less overall decrease in the male rate over-time (Figure 3.3.4).

When the sex-specific age-standardized rates for Middlesex-London were considered more closely, there was an interesting pattern whereby an increase in the male all-cause mortality rate in 2009 and again in 2012, precedes an increase in the female rate a year later (Figure 3.3.4).

Interpretation
Significant declines in all-cause age standardization rates in the decade from 2006 to 2015 in Middlesex-London indicate an overall positive improvement in the population’s health. However, recent flattening of the rate, within the context of continued improvement in Ontario may be signaling that Middlesex-London could be undergoing a change in population health that warrants further attention.

Sub-group differences in death from all causes

Urban population centres had a significantly higher all cause age-standardized mortality rate than rural areas for the last three years of available date from 2013 to 2015 (Figure 3.3.5).

Interpretation
When looking within Middlesex-London, all-cause mortality for residents in the rural areas outside of the small population centres (e.g., Strathroy) and large population centres (i.e., City of London) was significantly better than those in the urban areas. This finding is inconsistent with overall trends in Ontario overall where city dwellers and the well-off experienced the greatest gains in the last 40 years.3

Given that it was not possible to look at all-cause mortality by income group, further analysis of income by region might help to understand the differences found by urban and rural regions more fully.

Interpretive Notes

All-cause mortality is based on the residence of the deceased at the time of death as opposed to where the death took place.

How this Indicator was Calculated: 
Ontario Public Health Standard: 

Population Health Assessment and Surveillance Protocol, 2018

Ontario Public Health Standards: Requirements for Programs, Services, and, Accountability - Transparency and Demonstrating Impact (p. 71)

References:

1.  Buajitti E, Chiodo S, Watson T, Kornas K, Bornbaum C, Henry D, Rosella LC. Ontario atlas of adult mortality, 1992-2015 [Internet]. Version 2.0: trends in public health units. Toronto (ON): Population Health Analytics Lab; 2018 [cited 2019 May 27]. 87 p. Available from: https://pophealthanalytics.com/wp-content/uploads/2019/03/OntarioAtlasOf...

2.  Government of Ontario, Ministry of Health and Long-Term Care. Ontario public health standards: requirements for programs, services, and accountability [Internet]. Toronto (ON): Ministry of Health and Long-Term Care; 2018 Jan 1 [revised 2018 Jul 1]. Figure 6, Public health indicator framework for program outcomes and contributions to population health outcomes; [cited 2019 May 27]; p. 73. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/d...

3.  Henry D, Buajitti E, Rosella L. Regional inequalities in all-cause and premature mortality in Ontario. Healthc Pap [Internet]. 2018 Jan [cited 2019 May 27]; 17(3):28 Available from: https://www.researchgate.net/publication/326075530_Regional_Inequalities...

Last modified on: June 21, 2019

Jargon Explained

Age-standardized mortality rate
Number of deaths that would occur for a given population if that population had the same age distribution as the 1991 Canadian population.

Crude mortality rate
Total number of events (e.g., deaths, births, hospitalizations) divided by the total population for a given time period and geography. If one is interested in knowing the true event rates in a particular geographic area, then unadjusted or crude rate should be used instead of age standardized rate.