This online tool can be used to identify trends in substance attributable deaths, hospitalizations, and premature deaths in the province of British Columbia (BC). The tool presents counts, non-standardized rates, and standardized rates for the outcomes of death, hospitalization, and premature death for eight substances: alcohol, cannabis, cocaine, depressants, opioids, stimulants, tobacco, and other substances from the years 2007 to 2019. These data can be broken down by BC Health Boundaries (Health Authorities (HA), Health Service Delivery Areas (HSDA), Local Health Areas (LHA)) and whether the substance is wholly or partially attributable to the outcome. (Note that in 2018, the Local Health Area (LHA) were updated with new LHA numbers to align with other Ministry geographies and some LHA names to better represent the regional geography. This tool orginally used the 2012 LHA names but has been updated using the 2018 names. More details can be found here.)
The counts and non-standardized rates for the three outcomes for all substances can be further broken down by health condition, gender, and age group. Note that for substances except tobacco, the age groups used are: 15-34, 35-64, 65+ (counts for age group 0-14 are assumed to by zero for all substances and outcomes). For tobacco the age groups used are: 34-55, 55-64, 65-74, 75+ (counts for age group 0-34 are assumed to by zero for all substances and outcomes).
Counts of substance-attributable deaths, premature deaths and hospitalizations are calculated using the condition-based alcohol attributable fraction method. This technique is widely used globally for quantifying alcohol-caused health harms, e.g. see Sherk et al., 2017; World Health Organization, 2018; Canadian Substance Use Costs and Harms Scientific Working Group, 2018. Using the attributable fraction method means that a count of 1 does not necessary correspond to a specific, single individual. For example, if a particular condition had an attributable fraction of 0.2, a count of 1 would correspond to five individuals (5 x 0.2).
Non-standardized rates are calculated for each region/age_group/gender/year by dividing the counts by the population size for the age group and gender for that region for that year and then multiplying by 100,000. The BC population estimates are from BC Stats.
Note that in order to maintain confidentiality of personal information, the following restrictions are placed on the data:
- Counts greater than zero and less than six are suppressed.
- Non-standardized rates calculated from counts greater than zero and less than six are suppressed.
Note that while the raw count data are broken by genders Male, Female, and those who do not identify as Male or Female (gender Other), the counts in the gender Other category are either zero or below the suppression threshold (even at the highest levels of aggregration). As such the gender Other category is suppressed for all Counts. Furthermore, there are no rate data (Standardized or Non-standardized) available for gender Other as, as of latest update to the tool (Dec. 2021), Statistics Canada (and in turn BC Stats) do not provide any population estimates for those who do not identify as Male or Female.
In this tool, the standardized rates are standardized to the census year, 2016. The standardized rates are calculated as follows:
- The number of counts (cases) are calculated for the regions of interest (HAs or HSDAs) by year by age group by gender and then adjusted for Attributable Fractions (AF) based on International Classification of Diseases (ICD) code. The age groups used (for substances except tobacco) are: 15-34, 35-64, 65+ (counts for age group 0-14 are assumed to by zero for all substances and outcomes). For tobacco, the age groups used are: 34-55, 55-64, 65-74, 75+ (counts for age group 0-34 are assumed to by zero for all substances and outcomes).
- Non-standardized rates are calculated for each region/age_group/gender/year by dividing the counts in step 1. by the population size for the age group and gender for that region for that year and then multiplying by 100,000.
- Each non-standardized rate is multiplied by the proportion of people in that specific age group using 2016 BC census data from Statistics Canada and the proportion of people in that gender in 2016.
- The male and female results in step 3 are added together for each region/age group/year.
- Age group results in step 4 are added together for each region and year yielding the standardized rate.
Note that as a result of the way the standardized rates are calculated, standardardized rates only exist for gender='All' and age group='All'. Also the populations from the 2016 census (from Stats Canada) are not the same as the 2016 population estimates from BC Stats.
The health conditions for all substances are:
- Neuropsychiatric conditions
- Unintentional injuries
The health conditions for all substances except tobacco are:
- Communicable diseases
- Intentional injuries
- Motor vehicle collisions
The health condition for alcohol only is:
The health conditions for tobacco only are:
The health conditions for alcohol and tobacco only are:
- Cardiovascular conditions*
- Endocrine conditions*
Note the following restrictions on the tools:
- For the Graph tool, a maximum of eight lines can be displayed on the graph.
- For the Map tool, for a particular set of selections, the color ranges are calculated across all years for that particular set of selections, so maps for the different years for that particular set of selections can be compared.
- For the Bar Chart tool, a maxmimum of four bars per region or substance can be displayed.
- For the Pie Chart tool, only HA regions can be displayed for the By region selection.
- Canadian Substance Use Costs and Harms Scientific Working Group. (2018). Canadian substance use costs and harms (2007-2014). (Prepared by the Canadian Institute for Substance Use Research and the Canadian Centre on Substance Use and Addiction.) Ottawa, ON: Canadian Centre on Substance Use and Addiction:
- Sherk, A., Stockwell, T., Rehm, J., Dorocicz, J. & Shield, K. D. (2017). The International Model of Alcohol Harms and Policies (InterMAHP): A comprehensive guide to the estimation of alcohol-attributable morbidity and mortality. Version 1.0: December 2017. Canadian Institute for Substance Use Research, University of Victoria, British Columbia, Canada. www.intermahp.cisur.ca .
- World Health Organization. (2018). Global status report on alcohol and health. Geneva, Switzerland: World Health Organization .
*Cardiovascular conditions and Endocrine conditions for alcohol can potentially have negative counts or non-standardized rates. This reflects the literature that indicates that low consumption of alcohol may have a protective effect for these two conditions.