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This study summarizes the linkage of the Canadian Community Health Survey (CCHS) and the Canadian Mortality Database (CMDB), which was performed to examine relationships between social determinants, health behaviours and mortality in the household population.

Data and Methods

The 2000/2001-to-2011 Canadian Community Health Surveys were linked to the 2000-to-2011 CMDB using probabilistic methods based on common identifiers (names, date of birth, postal code and sex) for eligible respondents (85%; n = 614,774). Mortality records from January 1, 2000 through December 31, 2011 for people aged 12 or older were eligible for linkage (n = 2.774 million). The linkage was enhanced with information from the Historical Tax Summary File. Quality assessment consisted of internal and external validation. Cox survival analysis (age-adjusted) was conducted to estimate hazard ratios (HRs) associated with selected health behaviours.


Overall, 5.3% of eligible CCHS respondents linked to a mortality record; false positive and false negative rates were 0.04% and 2.43%, respectively. Linkage rates were higher among males (5.8%) and people aged 75 or older (20.2%), reflecting known mortality risks. Survival analyses confirmed elevated mortality risk associated with heavy (HR 2.36, CI 1.84, 2.89) and light smoking (HR 1.91, CI 1.52, 2.33), compared with not smoking; underweight and obesity, compared with normal and overweight; low fruit and vegetable consumption; and lack of physical activity.


Linking health behaviour information from the CCHS to mortality data from the CMDB allows for a greater understanding of modifiable determinants of mortality.


Data linkage, health survey, mortality, risk factors


In most industrialized countries, vital statistics registries and national health surveys are cornerstones of health surveillance.

Mortality data compiled by vital statistics registries for administrative purposes can be tabulated by basic demographic characteristics (age and sex), province and cause of death. However, little is known about the socioeconomic, cultural or linguistic characteristics of those who die, or about the contributions of lifestyle and social factors to mortality risk. [Full Text]


Claudia Sanmartin (Claudia.sanmartin@statcan.gc.ca), Michael Tjepkema, Philippe Finès and Douglas G. Manuel are with the Health Analysis Division, Yves Decady is with the Health Statistics Division, Richard Trudeau is with the Special Surveys Division, and Abel Dasylva is with the Household Survey Methods Division at Statistics Canada. Rick Burnett is with Health Canada. Nancy Ross is with McGill University. Douglas G. Manuel is also with the Ottawa Hospital Research Institute.

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What is already known on this subject?

  • Vital statistics registries and national health surveys are complementary sources of data.
  • When administrative and health survey data are combined through record linkage, relationships between social determinants and health outcomes such as death can be analyzed in more depth.
  • In Canada, mortality data have been linked to census results to examine differences in the risk of death across socioeconomic groups and to calculate mortality rates for subpopulations such as immigrants and Indigenous people.
  • An Ontario study used linked health survey and mortality data to explore associations with smoking, diet, physical activity and stress.

What does this study add?

  • Data from the 2000/2001 to 2011 Canadian Community Health Survey (CCHS) have been linked to the Canadian Mortality Database (CMDB).
  • Overall, 5.3% of CCHS respondents were linked to a death record in the CMDB.
  • The similarity of patterns in mortality rates based on the linked data and those in nationally reported estimates indicates that the linked data are suitable for studying mortality at the population level in Canada.

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