Provisional death counts and excess mortality, January 2020 to March 2021

Released: 2021-06-07

COVID-19 continues to affect communities and families in Canada. Beyond deaths attributed to the disease itself, the pandemic could also have indirect consequences that increase or decrease the number of deaths as a result of various factors, including delayed medical procedures, increased substance use, or declines in deaths attributable to other causes, such as influenza.

To understand both the direct and indirect consequences of the pandemic, it is important to measure excess mortality, which occurs when there are more deaths during a period of time than what would be expected for that period. It should be noted that, even without a pandemic, there is always some year-to-year variation in the number of people who die in a given week. This means that the number of expected deaths should fall within a certain range of values. There is evidence of excess mortality when weekly deaths are consistently higher than the expected number, but especially when they exceed the range of what would be expected over consecutive weeks.

After significant excess mortality had been observed since September 2020, the number of excess deaths in Canada started to decline through January and February. Almost 12 months after the start of the pandemic, from March 2020 to early March 2021, there were an estimated 18,511 excess deaths in Canada, or 6.7% more deaths than expected, after accounting for changes in the population, such as aging.

As part of Statistics Canada's commitment to providing timely and relevant information on COVID-19 and its impact on Canadians, a new updated provisional dataset from the Canadian Vital Statistics Death Database, covering the period from January 2020 to March 2021, was released today. Updates were also made to the provisional death estimates, which have been adjusted, where possible, to account for the incomplete nature of the counts. The provisional estimates will continue to be revised in future releases as more information is reported by provincial and territorial vital statistics agencies and as estimation methods continue to be enhanced.

The second period of excess mortality in Canada is longer but resulted in fewer deaths per week than the first

In the first 12 months of the COVID-19 pandemic, Canada experienced significant overall excess mortality over two distinct periods—from the onset of the pandemic in March to June 2020, and again from September 2020 through to the beginning of February 2021. These periods corresponded with elevated levels of deaths directly attributable to COVID-19 itself. Excess mortality was observed at other times for some subpopulations, though not necessarily linked to the disease itself.

In the first months of the pandemic, from March to June 2020, 8,423 more lives were lost than expected. This is closely aligned with the 8,510 deaths caused by COVID-19 over the same period, which disproportionately affected Canadians older than 64, particularly in Quebec and Ontario. This period saw an average of 765 excess deaths per week. The number of excess deaths and deaths caused by COVID-19 peaked in the last two weeks of April 2020. There were 2,705, or 24.4%, more deaths than expected in those two weeks, and this is very closely aligned with the 2,715 deaths caused by COVID-19 during the same period.

Infographic 1 
Provisional adjusted weekly number of deaths, expected number of deaths and COVID-19 deaths, Canada, January 2020 to July 2020 

In the fall, the number of excess deaths and deaths attributable to COVID-19 started to rise again. From the end of September 2020 to the beginning of February 2021, there were 9,117, or 7.9%, more deaths than expected. Over the same period, 9,975 lives were lost to COVID-19. While this second period of excess mortality was almost twice the length of the first period (in the spring of 2020), the average number of excess deaths per week was lower, at 456. The peak of this period was also less pronounced, with the highest number of excess deaths being observed in the first week of December, at 828, or 14.6%, more deaths than expected.

Infographic 2 
Provisional adjusted weekly number of deaths, expected number of deaths and COVID-19 deaths, Canada, July 2020 to February 2021 

Excess mortality less in line with deaths attributable to COVID-19 as pandemic continues

Since the start of the pandemic, the overall number of excess deaths and the number of deaths caused directly by COVID-19 have been closely related. However, as the pandemic continued, these trends began to diverge. A closer examination of the patterns for different age groups reveals a growing disconnect between the population groups experiencing excess mortality and those most affected by COVID-19 deaths.

Since the start of the pandemic, individuals older than 84 have experienced a disproportionate share of both excess deaths and COVID-19-caused deaths. From March 2020 to early March 2021, about 36% of the excess mortality and 54% of the deaths caused by COVID-19 observed in Canada involved individuals older than 84. In the first period of excess mortality, there were 4,197 excess deaths among this older population, coinciding with 4,725 deaths caused by COVID-19. In the second period of excess mortality, the gap between these two numbers widened, with 3,691 excess deaths and 5,420 COVID-19-caused deaths, according to the provisional data. The higher number of COVID-19 deaths may be attributable to the disease taking a heavy toll on some individuals who may have been at a high risk of dying over this period of time, regardless of the pandemic. In addition, the indirect effects of the pandemic, possibly resulting in decreases in the number of deaths attributable to other causes, could also be at play.

Similarly, those aged 65 to 84 have also been disproportionately impacted by COVID-19. From March to June 2020, in the first period of excess mortality, this age group experienced 2,976 excess deaths and 3,295 deaths caused by COVID-19. Similar to their older counterparts, the gap between these two figures widened for the second period of excess mortality. From September 2020 to February 2021, there were 3,148 excess deaths, compared with 3,980 deaths attributable to COVID-19, among those aged 65 to 84.

For those younger than 65, the number of excess deaths remained higher than the number of deaths attributable to COVID-19.

Among those aged 45 to 64, there were 3,028 more deaths than expected and 1,120 deaths caused by COVID-19 from March 2020 to early March 2021. These deaths accounted for 16% of excess deaths over this period and 6% of COVID-19-caused deaths.

Finally, those younger than 45 represent less than 1% of the total number of COVID-19 deaths during the pandemic reported to date. However, this age group did experience significant excess mortality during this reference period. From the beginning of May 2020 to mid-February 2021, an estimated 13,140 deaths were reported among Canadians aged 0 to 44, an excess of 2,151 deaths. Unlike for other age groups, these figures did not follow the same kind of pattern as COVID-19 deaths. They were at their highest from July to October 2020, averaging 67 excess deaths per week—25.6% more deaths than expected if there was no pandemic. Males accounted for much of this excess, which was seen particularly in Alberta and British Columbia. Given that about 105 COVID-19 deaths have been attributed to this age group to date, these figures are likely related to other factors, such as the indirect effects of the pandemic. Some provincial authorities, such as in Alberta, have reported that more deaths were attributed to overdoses in 2020 than in any previous year.

Infographic 3 
Provisional adjusted weekly number of deaths and expected number of deaths, ages 0 to 44 years, Canada, May to November 2020 

Only cancer and heart disease led to more deaths in 2020 than COVID-19

Information on cause of death is about 93% complete for the 2020 reference year. Deaths investigated by coroners or medical examiners, such as suicides, accidents and homicides, often require lengthy investigation. Consequently, information on the causes of death, particularly among people younger than 45, whose deaths are more likely to result in an investigation, typically requires more time before it is reported to Statistics Canada.

Based on the provisional information currently available to Statistics Canada, COVID-19 was the third most common cause of death in 2020 (5%), behind cancer (26%) and heart disease (17%).

In the first period of excess mortality in Canada, from March to June 2020, COVID-19 (18%) and heart disease (18%) were the most common causes of death among individuals aged 85 and older. During the second period of excess mortality in 2020 and 2021, the percentage of COVID-19-caused deaths among the 85-and-older age group dropped to 11%, falling behind heart disease (18%) and cancer (13%).

Among 65- to 84-year-olds, COVID-19 was the third most common cause of death in both the first and second periods of excess mortality. However, the proportion of deaths attributable to COVID-19 dropped from 11% to 7% between the first and second periods. Within this age group, cancer was consistently identified as the underlying cause of death in one-third of all deaths, and 15% of deaths were attributed to heart disease.

COVID-19 ranked lower as a cause of death among those younger than 65. Cancer (35%), heart disease (14%) and accidents (5%), which include accidental overdoses, traffic fatalities and other unintentional injuries, were the three most common causes of death among 45- to 64-year-olds. Approximately 2% of deaths within this age group were caused by COVID-19 over the same period.

Among those aged 0 to 44, the cause of death information is incomplete in 28% of deaths in 2020. Accidents (19%), cancer (10%) and intentional self-harm (10%) were the three most common causes of death reported so far among this age group.

The emergence of COVID-19 variants of concern and the rollout of COVID-19 vaccination strategies in Canada will likely result in further changes to the dynamics of the COVID-19 pandemic. To better understand the evolving impacts of the pandemic on mortality in Canada, Statistics Canada will continue to provide timely information on a regular basis on excess deaths, causes of death and comorbidities as it becomes available.

Products

To facilitate the identification of trends in excess deaths by province or territory, the interactive visualization tool "Provisional weekly estimates of the number of deaths, expected number of deaths and excess mortality: Interactive Tool" has been updated.

To facilitate the identification of trends in the number of weekly deaths by age group and sex and by province or territory, the interactive visualization tool "Provisional weekly death counts: Interactive tool" has also been updated.

Contact information

For more information, or to enquire about the concepts, methods or data quality of this release, contact us (toll-free 1-800-263-1136; 514-283-8300; STATCAN.infostats-infostats.STATCAN@canada.ca) or Media Relations (613-951-4636; STATCAN.mediahotline-ligneinfomedias.STATCAN@canada.ca).