Analysis

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This analysis focuses on the ranking and trends of the 10 leading causes of death in Canada. The analysis is divided into seven sections:

Section A: presents an overview of the 10 leading causes of death.
Section B: compares the ranking for males and females.
Section C: analyzes the age-standardized mortality rates.
Section D: examines the ranking patterns of nine broad age groups.
Section E: describes the regional differences for the five leading causes of death.
Section F: analyzes the 10 leading causes of infant death.
Section G: compares the differences and similarities between Canada and the United States.

For analysis of sections A, B, C, D, E and G, the 10 leading causes of death were derived from the list of 50 rankable causes of death (see Introduction section and Appendix 1). In sections F and G, the 10 leading causes of infant death were derived from the 71 rankable causes of infant death (see Introduction section and Appendix 2).

A. Overview of the 10 leading causes of death in Canada

Cancer and heart disease were the top two leading causes of death in Canada in 2004

The 10 leading causes of death in Canada accounted for 78.9% of all deaths in 2004. They were: (1^st) Malignant neoplasms or cancer (29.5% of deaths), (2^nd) Diseases of the heart or heart disease (22.9%), (3^rd) Cerebrovascular diseases or stroke (6.5%), (4^th) Chronic lower respiratory diseases (4.4%), (5^th) Accidents or unintentional injuries (4.0%), (6^th) Diabetes mellitus or diabetes (3.5%), (7^th) Influenza and pneumonia (2.5%), (8^th) Alzheimer’s disease (2.4%), (9^th) Intentional self–harm or suicide (1.6%), and (10^th) Nephritis, nephrotic syndrome and nephrosis or kidney disease (1.6%). The top five leading causes of death accounted for 67.3% of all deaths.

In 2004, cancer and heart disease were responsible for over half (52.4%) of all deaths in Canada.

From 2000 to 2004, the ranking order of the 10 leading causes of death in Canada remained unchanged with two exceptions: Alzheimer’s disease, and Influenza and pneumonia, which switched position in 2004 (Table A.1).

In this five–year period, the proportions of deaths attributed to the top three leading causes of death (cancer, heart disease, and stroke) decreased from 61.1% to 58.9%.

From 2000 to 2004, deaths due to cancer increased, while they decreased for heart disease and stroke. The proportion of deaths due to cancer increased from 28.7% to 29.5%, while it decreased for heart disease, from 25.3% to 22.9%, and for stroke, from 7.1% to 6.5%.

The proportion of deaths attributed to the other seven leading causes of death changed slightly during this period. Two of these seven leading causes showed a small reduction: Chronic lower respiratory diseases and suicide. The proportions of the other five leading causes of death increased, and the most noticeable increase was for diabetes, which went from 3.1% in 2000 to 3.5% in 2004.

B. Sex differences and similarities of the 10 leading causes of death in Canada

The ranking of the top three leading causes of death were the same for males and females in 2004

Although males and females shared the same 10 leading causes of death in 2004, those causes did not have the same ranking. Males and females did, however, have an identical ranking for six leading causes of death: (^1st) cancer, (2^nd) heart disease, (3^rd) stroke, (6^th) diabetes, (8^th) Influenza and pneumonia, and (9^th) Nephritis, nephrotic syndrome and nephrosis (Table B.1).

In 2004, the top five leading causes of death for males accounted for 68.8% of all male deaths, while for females, they accounted for 66.0% of all female deaths.

The largest difference in the ranking of leading causes for males and females in 2004 was for Alzheimer’s disease, where it ranked 5^th for females and 10^th for males. The two external causes of death, unintentional injuries and suicide, ranked 4^th and 7^th place for males, respectively, and 7^th and 10^th for females. Also, Chronic lower respiratory diseases ranked 4^th for females and 5^th for males.

The top three leading causes of death remained unchanged for males and females, from 2000 to 2004

The rankings of the top three leading causes of death for males and females–cancer, heart diseases, and stroke–remained unchanged from 2000 to 2004 (Table B.2).

Although some of the seven other leading causes of death switched ranks during this period, the greatest difference in ranking between males and females was for the following leading causes: unintentional injuries, suicide and Alzheimer’s disease (Table B.2).

Unintentional injuries were the fifth leading cause of death from 2000 to 2004 for both sexes combined, but they ranked fourth for males in 2002 and 2004 and fifth in 2000, 2001 and 2003. For females, unintentional injuries ranked seventh in all five years.

From 2000 to 2004, suicide was the ninth leading cause of death for both sexes combined. However, suicide ranked 7^th for males in all years and 10^th for females in all years except for 2002, when it ranked 11^th.

Alzheimer’s disease ranked seventh from 2000 to 2003 and eighth in 2004, when both sexes are combined. However, there are remarkable differences between the sexes. For males, Alzheimer’s disease ranked 10^th for all years except 2001 (when it was 9^th). Meanwhile, it ranked fifth for females in 2000, 2001 and 2004, and sixth in 2002 and 2003.

Decrease in the proportion of deaths due to heart disease more pronounced for females than males

From 2000 to 2004, the proportion of deaths due to cancer increased at the same pace for males and females. In contrast, the overall decrease in the proportion of deaths due to heart disease was slightly more pronounced for females (it went from 24.7% in 2000 to 22.2% in 2004) compared with males (25.8% in 2000 to 23.6% in 2004) (See Chart B.1). Therefore, from 2000 to 2004, the male–female ratio of the proportion of deaths due to heart disease widened, from 104.7 males per 100 females in 2000 to 106.3 males per 100 females in 2004.

From 2000 to 2004, the proportion of deaths for the 10 leading causes of death combined also declined more for females (79.4% to 77.7%) than for males (81.3% to 79.9%).

C. Trends in age–standardized mortality rates of leading causes of death, 2000 to 2004

Age–standardizing mortality rates were calculated to eliminate the impact of population structure changes on death rates. Thus, the comparisons of these mortality rates reflect the actual changes in mortality.

Age-standardized mortality rates for cancer and heart disease declined from 2000 to 2004

The age–standardized mortality rates for the two leading causes of death, cancer and heart disease, dropped from 2000 to 2004. Cancer standardized mortality rates dropped by 3.7% from 180.4 per 100,000 standard population in 2000 to 173.7 in 2004, while heart disease rates dropped by 16.6% from 152.0 to 126.8.

From 2000 to 2004, the decline in standardized mortality rates for cancer was more pronounced for males (5.9%), from 225.3 to 212.1, compared with the decline for females (1.6%), from 149.4 to 147.0. Meanwhile, the standardized rates for heart disease dropped 17.2% for males (202.9 to 168.1) and 16.6% for females (113.4 to 94.6).

For the period 2000 to 2004, the standardized mortality rate for all causes combined declined 7.1%, from 615.5 to 571.9. The largest reductions occurred from 2003 to 2004 and 2000 to 2001 (Table C.1). The standardized rates in these two periods dropped sharply, mainly because of the substantial reduction in the rates for heart disease and, to a lesser extent, because of the decline in the rates for stroke and cancer.

Standardized mortality rates for all causes of death declined for males by 8.8% (from 778.3 to 710.0) during this period, while rates for females declined by only 5.6% (from 493.2 to 465.6).

From 2000 to 2004, standardized mortality rates decreased for all 10 leading causes of death with the exception of Diabetes mellitus, and Influenza and pneumonia. The standardized rates for stroke decreased the most during this period, by 17.3% (42.2 to 34.9).

D. Age differences in the 10 leading causes of death in 2004

Table D.1 illustrates the pattern of the 10 leading causes of death across nine broad age groups.

In 2004, the ranking of the top 10 leading causes of death fluctuated widely by age group. Nonetheless, some causes had the same rank across certain age groups. For people aged 1 to 44 years, Accidents (unintentional injuries) or suicide or both causes were among the top two leading causes of death in 2004. However, for those aged 45 and older, cancer and heart disease surpassed the two external causes of death and became the top two leading causes of death (Table D.1).

For those aged 1 to 44 years, unintentional injuries or suicide or both were among the top two leading causes of death in 2004

In 2004, the top three leading causes of deaths for those aged 1 to 14 were unintentional injuries, cancer and congenital abnormalities, which accounted for 30.9%, 18.0%, and 8.8% of all deaths for that age group, respectively. Combined, they accounted for 57.7% of deaths for those aged 1 to 14 (Table D.1).

The top three leading causes of deaths for those aged 15 to 24, 25 to 34 and 35 to 44 were unintentional injuries, suicide and cancer. The relative burden of these three causes combined was responsible for 71.3%, 63.1% and 56.2% of deaths for these age groups, respectively.

In 2004, unintentional injuries ranked first for the younger age groups, those aged 1 to 14, 15 to 24 and 25 to 34, but placed second at age 35 to 44.

Cancer ranked second for those aged 1 to 14, third for those aged 15 to 34 and was the top leading cause of death for those aged 35 to 44.

Suicide ranked fourth for those aged 1 to 14, up to second for those aged 15 to 24, and down to third for those aged 25 to 44.

Homicide ranked sixth for those aged 1 to 14, up to fourth (its highest rank) for those aged 15 to 24, before dropping to fifth and ninth ranks for those aged 25 to 34 and 35 to 44, respectively.

Heart disease ranked fifth for those aged 1 to 24 and went up one rank (fourth) for those aged 35 to 44.

Congenital abnormalities ranked high (3^rd) only in the youngest age group, subsequently dropped to 6th place for those aged 15 to 34 and 10^th for those aged 35 to 44.

Human immunodeficiency virus (HIV) had an erratic pattern across age groups. It ranked 7^th for those aged 25 to 34, then jumped to 5^th place for those aged 35 to 44, before dropping to 10^th place for those aged 45 to 54.

Cancer and heart disease were the top two leading causes of death in 2004 for those aged 45 years and older

For people aged 45 and older, the top two leading causes of death, cancer and heart disease, replaced unintentional injuries and suicide, the leading causes of death in younger age groups.

The relative burden of cancer and heart disease combined accounted for 56.7%, 66.7%, 63.9%, 54% and 43.8% for those aged 45 to 54, 55 to 64, 65 to 74, 75 to 84, and 85 and over, respectively.

Unintentional injuries ranked third for those aged 45 to 54, fourth for those aged 55 to 64 and dropped to sixth and eighth for those aged 65 to 74, 75 and older, respectively.

Suicide’s ranking also dropped in older age groups from fourth for those aged 45 to 54 to eighth for those aged 55 to 64. For those aged 65 and older, suicide was not among the 10–leading causes of death.

Cancer ranked first for the four 10–year age groups from 45 to 84 and second for those aged 85 and older.

Heart disease ranked second for the 10–year age groups from 45 to 84 and then it surpassed cancer at age 85 and over to be the top leading cause of death.

Stroke ranked low (sixth) for those aged 45 to 54, but ranked higher in older age groups, being fifth, fourth and third for those aged 55 to 64, 65 to 74 and 75 and older, respectively.

Diabetes also emerged from seventh rank for those aged 45 to 54, up to third rank (its highest) at age 55 to 64 and down to fifth and seventh for those aged 65 to 84 and 85 and older, respectively.

Chronic lower respiratory disease ranked ninth for those aged 45 to 54, then it jumped to seventh and third (its highest rank) for those aged 55 to 64 and 65 to 74. After that it dropped to fourth and sixth for those aged 75 to 84 and 85 and older, respectively.

Influenza and pneumonia and Alzheimer’s disease also ranked higher in older population. Influenza and pneumonia climbed one rank for each age group, from ninth for those aged 55 to 64 to seventh for those aged 75 to 84, finally placing fifth (its highest rank) at age 85 and older. Meanwhile, Alzheimer’s disease ranked sixth and fourth for those aged 75 to 84 and 85 and older, respectively.

Liver disease was only among the 10 leading causes of death in four age groups: 35 to 44, 45 to 54, 55 to 64 and 65 to 74; and ranked seventh, fifth, sixth and seventh, respectively.

In 2004, the proportion of deaths due to cancer and heart disease had different patterns across age groups

In 2004, the relative burden of two main leading causes of death–cancer and heart disease–had different patterns across age groups (Chart D.1).

Cancer was responsible for small proportions of deaths in the younger age groups (those aged 1 to 34). The relative burden of cancer deaths increased for those aged 25 to 34 and reached its highest level for those aged 55 to 64, when almost half of all deaths (47.7%) were attributed to cancer. The proportion of deaths due to cancer lowered for those aged 65 to 74 (43.3%) and then declined sharply for those aged 85 and older (14.5%). (See Chart D.1)

In contrast, the relative burden of heart disease deaths increased steadily as the population aged and surpassed the relative burden of cancer deaths at age 85 and older. In younger age groups (those aged 1 to 34), the increase in the proportion of deaths due to heart disease from one age group to another was small. It went from 3.5% (ages 1 to 14) to 5.6% (ages 25 to 34). Subsequently, the pace of the increase augmented. The proportion of heart disease deaths jumped to 19% for those aged 54 to 64, and 29.2% for those aged 85 and older, when it exceeded the proportion of cancer deaths by two–fold.

The proportion of deaths due to unintentional injuries and suicide had similar patterns across age groups

In 2004, the relative burden of the two external causes of death, unintentional injuries and suicide, had similar trends across age groups; both having greater proportions of deaths in younger age groups (except for suicide, for those aged 1 to 14) and lower proportions in older age groups (Chart D.1).

Unintentional injuries were the top leading cause of death for those aged 1 to 34 (Table D.1). The highest proportion of deaths due to unintentional injuries, 42.5%, was for those aged 15 to 24. The lowest proportion was 1.9%, for those aged 65 to 74.

In 2004, suicide was among the 10 leading causes of death from the youngest age group to the 55–to–64 age group (Table D.1).

Suicide had its largest proportions of deaths for those aged 15 to 24 and 25 to 34 (21.6% and 21.7%, respectively). The proportion of deaths due to suicide decreased in the older age groups and was not among the 10 leading causes of death by age 65 and older.

In 2004, the relative burden of these four selected leading causes of death had important differences between the sexes across age groups.

The pattern of the proportion of deaths due to cancer was similar across age groups for males and females, whereas for heart disease, it was not

In 2004, the pattern of the proportion of deaths due to cancer was similar across age groups for males and females. However, the proportion of deaths attributed to cancer for females surpassed that for males in all age groups, with the exception of those aged 75 and older. The proportion of cancer deaths reached its peak (56%) for females aged 45 to 64, while it reached its peak for males 10 years older, at age 55 to 74, and at a lower level (42%). (See Chart D.2).

In 2004, the pattern of the proportions of deaths due to heart disease was different across age groups for males and females (Chart D.2). For males, the relative burden of heart disease deaths was low for the three younger age groups, those aged 1 to 34 years, but higher for those aged 35 to 44 and 45 to 54. The proportion of deaths due to heart disease reached a plateau for males aged 55 to 64 and 65 to 74, at 23%. The proportion was slightly higher, 29%, in the oldest age group, those aged 85 and older.

For females, the relative burden of heart disease had a pattern of a continuous increase across age groups. In the youngest age group, the proportion of heart disease deaths was 3.3%. The proportion increased slowly in the subsequent age groups and was up to 8.3%, for those aged 45 to 54. For women aged 55 and older, the proportion of deaths by heart disease climbed faster to catch up with men aged 85 and older. At age 85 and older, the proportion of deaths by heart disease for women, 29.5%, was the same as for men.

The widest gap between male and female proportions occurred for those aged 45 to 54, for both causes (cancer and heart disease).

Similar pattern in the proportions of deaths due to unintentional injuries and suicide emerged across age groups for males and females

In 2004, the pattern of the proportions of deaths across age groups was similar for unintentional injuries for both sexes, but it was slightly different between males and females for suicide (Chart D.3).

In 2004, the pattern of the proportions for unintentional injuries deaths was similar for males and females. However, the proportion of deaths for males surpassed that for females in all age groups except the two oldest. The widest gap between the sexes was at the youngest age group, 1 to 14 years (Chart D.3). Males and females aged 15 to 24 had the highest proportions of deaths due to unintentional injuries, 43.7% and 39.4%, respectively.

The relative burden of suicide deaths was higher for males than females in all age groups. The proportion of deaths by suicide was relatively low for males and females aged 1 to 14. For males, the percentage of deaths attributed to suicide peaked at age 25 to 34, while for females, it peaked at age 15 to 24. The largest discrepancy between the sexes occurred for those aged 25 to 34.

The relative burden of heart disease deaths declined between 2000 and 2004 for those aged 55 and older

Comparing 2000 to 2004, changes in the relative burden of cancer and heart disease were small; however, there was an important decline in the proportion of deaths due to heart disease for those aged 55 and older (Chart D.4).

For cancer, the proportion of deaths increased for those aged 1 to 14 (from 14.4% in 2000 to 18.0% in 2004) and for those aged 65 to 74 (40.9% to 43.3%) and 75 to 84 (27.8% to 29.9%). The proportions decreased slightly for those aged 15 to 54.

The proportion of deaths due to heart disease remained relatively stable from 2000 to 2004 for those aged 1 to 54, but declined for those aged 55 and older. The largest declines occurred in those aged 65 to 74 and 75 to 84, from 23.9% in 2000 to 20.5% in 2004 and 27.6% to 24.1%, respectively (Chart D.4).

As population ages, age-specific mortality rates increased at exponential speed

Compared with the proportions of deaths due to cancer and heart disease in 2000 and 2004, changes in age–specific mortality rates across age groups were much more striking. Cancer and heart disease age–specific mortality rates increased exponentially from the youngest to the oldest age groups (Chart D.5).

From 2000 to 2004, the most noticeable decline in age–specific mortality rates occurred in the cancer mortality rates for those aged 15 to 24 (from 4.7 per 100,000 population to 3.7) and in the heart disease mortality rates for those aged 55 to 64 (161.9 to 133.6), those aged 65 to 74 (484.4 to 372.9) and those aged 75 to 84 (1,407.7 to 1,151.5).

E. Geographic differences and similarities of five leading causes of death

Cancer and heart disease were the two top leading causes of death in 2004 for all provinces and two territories

In Canadian provinces and territories, cancer was the leading cause of death in 2004, with the exception of Newfoundland and Labrador, where it was heart disease. In provinces and territories except for Newfoundland and Labrador and Nunavut, heart disease ranked second. In Newfoundland and Labrador, cancer ranked second, and in Nunavut, suicide ranked second (Table E.1).

In 2004, cancer and heart disease were responsible for half of all deaths in the provinces. They were responsible for a low of 50.1% of deaths in Saskatchewan and British Columbia and a high of 54.5% in Prince Edward Island. The relative burden of cancer was the highest in Quebec (32.1% of deaths) and the lowest in Saskatchewan (25.3%). The relative burden of heart disease was the highest in Prince Edward Island (27.2%) and the lowest in Quebec (20.9%). In the territories, the proportions of deaths for the top two leading causes of death combined were less than 50%, 44.0% for Yukon, 43.8% for the Northwest Territories and 34.7% for Nunavut.

In the regions, where numbers are relatively small (under 100), and therefore, subject to random fluctuations, the results should be interpreted with caution. This mainly applies to the province of Prince Edward Island and the three territories.

Proportions of deaths dropped sharply from the second– to the third–leading cause of death in 2004

In 2004 in most provinces, the proportion of deaths due to the third–leading cause of death was much lower, at least three times less than those of the second–leading cause of death. The largest drop in the proportions of deaths from the second- to the third–leading cause of death was in New Brunswick, where the drop was from 26.0% to 6.0%, and the smallest drop was in British Columbia, from 21.9% to 7.7%.

Compared with the provinces, the drop in the proportion of deaths from the second to the third–leading cause of death was more gradual in the territories. The largest drop was in the Northwest Territories (from 18.3% to 7.2 %) and the lowest in Yukon (from 16.3% to 15.1%).

In 2004, the third–leading cause of death was stroke for all provinces, except Quebec. The relative burden of deaths due to stroke varied from 6.0% in New Brunswick to 8.4% in Prince Edward Island. In Quebec, Chronic lower respiratory diseases ranked third at 5.3% of all deaths.

The third–leading cause of death varied among the three territories in 2004. It was unintentional injuries (15.1%) in Yukon, suicide (7.2%) in the Northwest Territories and a tie between heart disease and unintentional injuries in Nunavut (11.6%).

Chronic lower respiratory diseases and unintentional injuries ranked as the fourth– or fifth–leading cause of death in most provinces in 2004. Diabetes ranked fourth in Newfoundland and Labrador, New Brunswick and Manitoba. Stroke ranked fourth in Quebec, and Influenza and pneumonia ranked fifth in Prince Edward Island and British Columbia,.

In Yukon, stroke (4.8%) and Chronic lower respiratory diseases (4.2%) were the fourth– and fifth–leading causes of death, respectively. In the Northwest Territories, stroke and unintentional injuries (5.9%) tied for fourth, while Certain conditions from the perinatal period (5.8%) ranked fifth in Nunavut.

For males and females, cancer and heart disease were the top two leading causes of death in the majority of provinces and territories in Canada

Cancer was the leading cause of death for males in 10 out of 13 provinces and territories in 2004. The three exceptions were Newfoundland and Labrador and Prince Edward Island, where heart disease was the leading cause of death, and Nunavut, where suicide was the leading cause (Table E.2).

For females, cancer was also the leading cause of death in 10 out of 13 provinces and territories. The three provinces with heart disease as the leading cause of female deaths were Newfoundland and Labrador, New Brunswick and Saskatchewan (Table E.3).

Heart disease was the second–leading cause of death for males in 9 out of 13 provinces and territories in 2004. Cancer was the second-leading cause of death for males in Newfoundland and Labrador, Prince Edward Island and Nunavut, and unintentional injuries tied with heart disease as second for males in Yukon.

Heart disease was also the second-leading cause of female deaths in 9 out of 13 provinces and territories in 2004. Cancer was the second–leading cause of death for females in Newfoundland and Labrador, New Brunswick and Saskatchewan, and suicide ranked second in Nunavut.

The relative burden of the top two leading causes for males was higher than that for females in all provinces in 2004. For males, the top two leading causes of death accounted for over half of all deaths in every province. They accounted for a low of 50.9% of male deaths in British Columbia and a high of 59.4 % in Prince Edward Island. For females, the top two leading causes of death in 2004 accounted for a low of 47.7% of deaths in Saskatchewan and a high of 52.4% in Alberta for the provinces.

In two out of three territories, the relative burden of the top two causes for females was higher than that for males in 2004. For males, it was 38.3% in Yukon, 41.6% in Nunavut and 46.5% in the Northwest Territories. For females, it was 51.4% in Yukon, 45.9% in Nunavut and 38.9% in the Northwest Territories.

Stroke ranked higher for females whereas unintentional injuries ranked higher for males in the Canadian provinces in 2004

Stroke ranked as the third–leading cause of death in all 10 provinces for females, but only in 5 provinces for males (Table E.2 and Table E.3).

In contrast, unintentional injuries ranked third in three provinces and fourth in five provinces for males; and they only ranked fifth in two provinces for females.

Chronic lower respiratory disease ranked higher for males than for females. For males, it ranked third in two provinces, fourth in two provinces and fifth in five provinces. For females, it ranked only fourth in four provinces and fifth in two provinces.

Two of the five leading causes of death only ranked among the top five for females: Alzheimer’s disease and Influenza and pneumonia. They were fourth or fifth in 8 out of 10 provinces.

Diabetes also appeared more often among the top five leading causes of death for females than for males. It was the fourth or fifth leading cause of death for females in four provinces, but only among the top five in two provinces for males.

In the Canadian territories, suicide was the first-, third- and fourth-leading cause of death for males and the second– and fifth–leading cause for females

In 2004, suicide was the top leading cause of death for males in Nunavut, the third in the Northwest Territories and the fourth in Yukon. In Yukon, suicide and homicide tied for fourth.

For females, suicide was the second–leading cause of death in Nunavut and was tied for fifth (with Influenza and pneumonia) in the Northwest Territories.

Although cancer and heart disease were the top two leading causes of death for males and females in two out of three territories, suicide and unintentional injuries also ranked high.

For females, cancer was the leading cause of death in all three territories, but for males it was only in Yukon and Northwest Territories.

Heart disease was the second-leading cause of death for males and females in the Northwest Territories and Yukon (where it tied with unintentional injuries for males).

For males, unintentional injuries ranked second in Yukon and fourth in the Northwest Territories and Nunavut. For females, unintentional injuries ranked as the third–leading cause of death in Yukon and Nunavut (it tied with Chronic respiratory disease in Nunavut) and fourth in the Northwest Territories.

From 2000 to 2004, the proportions of deaths due to cancer went up, and for heart disease they went down in most Canadian provinces and territories

From 2000 to 2004, most of the provinces and territories increased their proportions of deaths due to cancer and decreased due to heart disease. The three exceptions to this trend were New Brunswick and Nunavut, where the proportions of deaths due to cancer and heart disease both went up, and Newfoundland and Labrador, where they went down (Chart E.1).

From 2000 to 2004, the relative burden of cancer deaths climbed from 28.7% to 29.5% in Canada. During this period, the proportions of deaths due to cancer went up in 11 out of 13 provinces and territories. The biggest increase was in Nunavut (where it went from 21.5% in 2000 to 23.1% in 2004), followed by Yukon (26.9% to 27.7%), Prince Edward Island (26.0% to 27.3%) and Manitoba (26.1% to 27.4%). The relative burden of cancer deaths decreased in Newfoundland and Labrador and Northwest Territories, where they declined from 26.9% to 26.3% and from 27.4% to 25.5%, respectively.

In contrast, during the same period, the relative burden of heart disease deaths declined in Canada, from 25.3% in 2000 to 22.9% in 2004. Eleven out of 13 provinces and territories followed the same trend as the national level. The largest decline was in Yukon (from 19.9% in 2000 to 16.3% in 2004) followed by British Columbia (from 25.0% to 21.9%) and Quebec (from 23.6% to 20.9%). The only regions where the proportion of heart disease deaths increased were the Northwest Territories and New Brunswick, where they went from 13.4% in 2000 to 18.3% in 2004 and 25.7% to 26.0%, respectively.

From 2000 to 2004, proportions of deaths due to unintentional injuries increased in 8 out of 13 Canadian provinces and territories

From 2000 to 2004, the proportions of deaths due to unintentional injuries increased in 8 out of 13 Canadian regions and decreased in Newfoundland and Labrador, Saskatchewan, Alberta, British Columbia, and Northwest Territories. The change in the proportion of deaths due to unintentional injuries and suicide were in general less pronounced than changes for cancer and heart disease. (See Chart E.1 and Chart E.2)

Of all provinces and territories, the largest increase in the proportions of deaths due to unintentional injuries was in Prince Edward Island (where it went from 4.1% in 2000 to 6.0% in 2004), followed by Nunavut (10.0% to 11.6%) and Yukon (14.1% to 15.1%). The largest decrease in the proportions of deaths due to unintentional injuries was in the Northwest Territories (from 14.6% in 2000 to 5.9% in 2004) followed by Newfoundland and Labrador (3.9% to 2.9%) and Alberta (5.3% to 4.3%).

For suicide, 10 out of 13 provinces and territories presented some changes in the proportion of deaths between 2000 and 2004 and they were less pronounced than those for unintentional injuries. The largest increase in the proportion of deaths due to suicide was in the Northwest Territories (from 4.5% in 2000 to 7.2% in 2004), followed by Nunavut (19.2% to 19.8%). The largest decrease in the proportion of deaths due to suicide was in Yukon (4.5% in 2000 to 3.6% in 2004), followed by New Brunswick (1.9% to 1.4%).

From 2000 and 2004, two provinces and one territory showed increases in the proportions of deaths attributed to both unintentional injuries and suicide. Of these regions, Nunavut had the second largest increase in the proportion of deaths due to unintentional injuries and suicide. Ontario and Nova Scotia also had increases in the proportions of these two external causes of death.

Only Saskatchewan had a decrease in the proportion of deaths due to both causes. The proportion of unintentional injuries decreased from 4.9% in 2000 to 4.5% in 2004, and for suicide, it decreased from 1.4% to 1.3%.

Manitoba, Alberta and British Columbia did not have any change in the proportions of deaths due to suicide from 2000 to 2004.

F. Overview of the 10 leading causes of infant death in Canada

Congenital abnormalities and short gestation were responsible for over one third of infant deaths in Canada

In 2004, congenital abnormalities and short gestation were responsible for over one third (37.4%) of infant deaths in Canada (Table F.1).

The 10 leading causes of infant (under one year of age) death in 2004 were: (1^st) Congenital malformations, deformations and chromosomal abnormalities (congenital abnormalities); (2^nd) Disorders related to short gestation and low birth weight, not elsewhere classified (short gestation); (3^rd) Newborn affected by maternal complications of pregnancy (maternal complications of pregnancy); (4^th) Newborn affected by complications of placenta, cord and membranes (complications of placenta, cord and membranes); (5^th) Sudden infant death syndrome (SIDS); (6^th) Intrauterine hypoxia and birth asphyxia (intrauterine hypoxia); (7^th) Newborn affected by complications of labour and delivery (complications of labour and delivery); (8^th) Neonatal haemorrhages; (9^th) Respiratory distress of newborn (respiratory distress); and (10^th) Bacterial sepsis of newborn (bacterial sepsis).

The top 5 leading causes of death accounted for 56.2% of all infant deaths, while the top 10 accounted for 71.1%.

From 2000 to 2004, three leading causes of death, maternal complications of pregnancy, complications of placenta, cord and membranes and SIDS, changed ranks with each other, and maternal complications of pregnancy ranked third since 2001.

The biggest change in ranking from 2000 to 2004 was for complications of labour and delivery, which ranked 11^th in 2000 and 7th in 2004.

There was more variability in the lower ranked leading causes of infant death due to random fluctuations of small numbers (less than 100).

Congenital abnormalities and short gestation were two leading causes of infant death for five years, from 2000 to 2004

Two leading causes of infant deaths, congenital abnormalities and short gestation, held the number one and two spots every year from 2000 to 2004. The proportion of infant deaths due to both causes increased from 33.8% in 2000 to 37.4% in 2004. This was mainly due to the increase in the proportion of infant deaths by short gestation, which went from 9.3% in 2000 to 14.2% in 2004. During the same period, the proportion of deaths due to congenital abnormalities decreased from 24.5% to 23.2%. (See Chart F.1 and Table F.1)

Male and female infants had the same top three leading causes of infant death in 2004

Male and female infants shared the same ranking for the top three leading causes of infant death in 2004: (1^st) congenital abnormalities, (2^nd) short gestation and (3^rd) maternal complications of pregnancy. These three causes of infant death were responsible for 41.8% of deaths for male infants and 49.7% for female infants.

Two other leading causes of infant death that held the same ranking for males and females in 2004 were complications of placenta, cord and membranes (4^th) and respiratory distress (9^th). All other leading causes of infant death had different rankings for male and female infants.

In 2004, the 10 leading causes of infant death accounted for 68.5% of deaths for male infants and 74.1% for female infants.

For each year from 2000 to 2004, congenital abnormalities and short gestation were the top two leading causes of male and female infant deaths

The ranking of the top two leading causes of death, congenital abnormalities and short gestation, were the same for male and female infants every year from 2000 to 2004 (Table F.3).

Maternal complications of pregnancy; complications of placenta, cord and membranes; and SIDS traded places in the third, fourth, and fifth spots over the years, with occasional differences between sexes by one rank position. The only exception was in 2004, when SIDS dropped to seventh place for females, and complications of labour and delivery moved into fifth.

From 2000 to 2004, the gap between sexes widened for the top two leading causes of infant death

From 2000 to 2004, the proportion of deaths due to congenital abnormalities, the leading cause of infant death, was higher for female infants compared with male infants. However, the gap between sexes widened during this period, mainly because of the decline in the proportion of deaths due to congenital abnormalities for male infants (24.3% in 2000 to 21.3% in 2004). (See Chart F.2.)

Regarding the second-leading cause of infant death, short gestation deaths for female infants surpassed those for male infants in 2003. The proportion for female infant deaths increased gradually, from 9.2% in 2000 to 15.9% in 2004. Although the proportion of male infant deaths due to short gestation went up from 9.4% in 2000 to 15.1% in 2002, it dropped to 11.7% in 2003, below the proportion of female infant deaths (Chart F.2).

Infant mortality rate up by one third for the second-leading cause of infant death

From 2000 to 2004, the infant mortality rate for congenital abnormalities decreased by 5.9% from 129.9 per 100,000 live births to 122.2. In the same period, the infant mortality rate for short gestation jumped by one third from 49.4 in 2000 to 74.8 in 2004 (Chart F.3).

The male infant mortality rate for congenital abnormalities decreased from 142.5 per 100,000 male live births in 2000 to 117.2 in 2004. Meanwhile, the female infant mortality rate for this cause surpassed that for males in 2004 when it increased from 116.6 per 100,000 female live births in 2000 to 127.5 in 2004.

In contrast, for short gestation, the male infant mortality rate jumped from 55.2 in 2000 to 87.7 in 2002 and then dropped to 69.9 in 2004. During this period, the female infant mortality rate increased continuously from 43.3 to 79.9 and also surpassed that for males in 2004.

The male–female gap in the infant mortality rate for these two causes narrowed from 2000 to 2004, but it was slightly more pronounced for congenital abnormalities than for short gestation.

G. Canada–United States comparisons for leading causes of death in 2004

Cancer led heart disease in 2004 in Canada, but in the United Stated the ranking was reversed

Although the top 10 causes of death were generally similar in Canada and the United States, some differences emerged in 2004. A notable discrepancy was the ranking of cancer and heart disease.

Cancer led heart disease as the most common cause of death in Canada in 2004, but in the United States heart disease led cancer. In Canada, 30% of all deaths were attributed to cancer, compared with 23% in the United States. Conversely, 23% of all deaths were attributed to heart disease in Canada, compared with 27% in the United States (Chart G.1) stroke was the third-ranking cause of death in both countries.

In both countries the three leading causes–cancer, heart disease and stroke–accounted for just under 60% of all deaths; the top 10 leading causes accounted for nearly 80%.

The ranking of leading causes of death based on the number of deaths for cancer and heart disease in Canada and the United States was consistent with the ranking of age-standardized mortality rates for cancer and heart disease. Even when adjusted for differences between the population age structures in the two countries, the mortality rate for heart disease in Canada was substantially lower than in the United States: 128 deaths per 100,000 standard population, compared with 176 in the United States. For cancer, the age–standardized rates in Canada and the United States were more similar, at 174 and 164 deaths per 100,000 population, respectively (Chart G.2).

Aside from cancer and heart disease, 7 of the remaining 8 leading causes of death were the same in both countries, with minor differences in rankings for Influenza and pneumonia and Alzheimer’s disease. Suicide, the 9th–ranking cause of death in Canada, was not among the 10 leading causes in the United States. Septicemia was not among the 10 leading causes of death in Canada, but in the United States it ranked 10th.

Males and females in Canada had the same 10 leading causes of death as in the United States in 2004

Comparisons of sex–specific patterns in causes of death in Canada and the United States indicate that for each sex, the 10 leading causes were the same in both countries (Table G.2). However, there were differences between the sexes in the causes found in the top 10. For males but not females, suicide was among the 10 leading causes of death in both countries. For females but not males, Septicemia was included (as the 10^th–leading cause of death).

Rankings of the top 10 causes of death also differed slightly between countries and sexes. For Canadian males and females, cancer was the leading cause of death, while for American males and females, heart disease led cancer. For Canadian males, unintentional injuries were the fourth–ranking cause of death, but they ranked third for American males. Similarly, unintentional injuries ranked seventh for Canadian females, but sixth for American females.

Alzheimer’s disease was more important as a cause of death for females than for males; it ranked 5^th for Canadian and American females, but only 10^th for males in each country. In both countries, more than twice as many female deaths were attributed to Alzheimer’s disease than for male deaths.

Suicide ranked higher than homicide as a leading cause of death in Canada, while homicide ranked higher in the United States in 2004

Unintentional injuries were the leading cause of death in Canada for the age groups 1 to 14, 14 to 24 and 25 to 34. Beginning with those aged 35 to 44, cancer was the leading cause of death, as it was in all older age groups except those aged 85 or older, where it was heart disease. The pattern was similar in the United States, although unintentional injuries persisted as a leading cause of death longer into adulthood–to ages 35 to 44. Another discrepancy was that in the United States, heart disease overtook cancer as the leading cause of death in a younger age group than it did in Canada–in those aged 75 and older (Table D.1 and Table G.3).

In both countries, homicide was a relatively important cause of death for youths and young adults, but it ranked lower in Canada. For those aged 15 to 24, homicide ranked fourth in Canada and second in the United States. For those aged 25 to 34 and 35 to 44, the rankings were fifth and ninth in Canada and third and sixth in the United States, respectively. However, for suicide, Canada ranked slightly higher in these age groups compared with the United States. For those aged 15 to 24, it ranked second in Canada and third in the United States. For those aged 25 to 34, it ranked second in both countries. For those aged 35 to 44, it ranked third in Canada and fourth in the United States.

In both countries, Human immunodeficiency virus (HIV) disease appeared in the 10 leading causes of death for those aged 25 to 34, 35 to 44 and 45 to 54; in the United States, HIV was also among the top 10 causes for those aged 15 to 24. In both countries its highest ranking (fifth) occurred in the age group 35 to 44.

Stroke was among the leading 10 causes of death from ages 15 to 24 on; in that age group, it ranked seventh in Canada and the United States. Its growing importance as a cause of death with increasing age is reflected in its rise in the rankings over successive age groups. For those aged 25 to 34, stroke ranked ninth in Canada and eighth in the United States; for those aged 75 to 84, it ranked third in both countries. The largest discrepancy between the two countries was in the 35 to 44 age group, where stroke ranked sixth in Canada and eighth in the United States.

Eight of the top 10 leading causes of infant death were the same in Canada and the United States

The causes of death among infants (under one year of age) were fairly similar in Canada and the United States. Eight of the top 10 causes of death were the same in both countries. Congenital abnormalities and short gestation were the two leading causes of death in both countries.

Some international differences emerged. Notably, unintentional injuries were the fifth–leading cause of infant death in the United States, but were not among the top 10 causes in Canada. Intrauterine hypoxia, and complications of labour and delivery–the sixth– and seventh–leading causes of infant death in Canada— were not among the top 10 causes in the United States. Likewise, Diseases of the circulatory system, the 10^th–leading cause of infant death in the United States, were not among the top 10 causes in Canada. Differences in rankings may in part be a result of the smaller Canadian population; numbers for 6 of the 10 leading causes in Canada were relatively small (under 100), so subject to random fluctuation.