Mortality: Overview, 2007
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This section examines mortality in Canada primarily for the years 2006 and 2007 including infant mortality, the probability of dying and life expectancy for males and females. In 2007, vital statistics enumerated 235,200 deaths in Canada up from 228,100 deaths in 2006 (Figure 1 and Table 1). In fact, the number of deaths has been on an overall upward trajectory for most of the past century. There are two key reasons that account for this increasing number of deaths: a growing population and an aging population. First, a larger population results in higher numbers of deaths even when mortality rates are decreasing as they are in Canada. Secondly, as the population is aging, and the large baby boom cohort born between 1946 and 1965 reach their senior years, more deaths will occur as a greater number of people are exposed to higher mortality rates.
Most provinces across Canada reflected the national trend of more deaths in 2007 than in the previous year. Some provinces such as Newfoundland and Labrador and Saskatchewan, as well as the Yukon territory, had only marginal increases in the number of deaths in 2007 compared with 2006 while Prince Edward Island and the Northwest Territories experienced slight declines. Nunavut had the same number of deaths in both 2006 and 2007.
One of the indicators of the longevity of the population is the age at which most deaths occur. The highest number of deaths in 2007 occurred at age 87 for women and age 82 for men, reflecting the long lives of many people in Canada today. The fact that many men, and particularly women, are living well into their eighties shows not only the gains against overall mortality but also the increasing longevity after age 65, which can impact areas such as health services, care-giving, housing, and pension systems.
The age structure of deaths has changed substantially in recent decades. The population pyramid for the number of deaths per 1,000 population for 1921, 2007 and 2060, shows what has happened (in 1921 and 2007) and what is projected to happen (in 2060) according to a medium scenario on the future evolution of mortality (Figure 2). In 1921, it is apparent from the population pyramid that there were a fairly high number of deaths during infancy, below age one, and early childhood. While there was still a higher infant mortality in 2007 compared with mortality for older children, it was markedly lower than a century earlier. Similar to both 2007 and 2060, deaths per 1,000 population in 1921 were more concentrated in the senior years; they were, however, more evenly distributed all across age groups than in either 2007 or 2060. In 2007, the number of deaths per 1,000 population was concentrated for men and women between 75 and 90 years of age, a phenomenon also known as the compression of mortality. By 2060, the distribution of deaths by age could be even more concentrated at older ages.
The probability of dying, which is relatively high in the first year of life, is low throughout childhood and young adulthood (Figure 3). In fact, the mortality rate of the first year of life for males and females in 2007 was not reached again until age 56 for men and age 59 for women. The lowest probability of dying for both boys and girls was at age 10. The probability of dying then increases quite sharply during the late teen years although it generally remains low until about the age of 35, then steadily increases at middle age and beyond for both men and women. The probability of dying is higher for males than females at almost every age throughout life, and this gap is particularly important during the late teens and twenties. Young adult males have a higher tendency to engage in risky behaviour that could result in a higher mortality related to external causes, for example, accidents. Moreover in addition to whatever behavioural differences may exist between the sexes, there also seem to be biological differences as reflected by the higher rates of infant mortality for males and the higher life expectancy for females compared with males throughout the life course.
Deaths by age group and month of the calendar year for 2007 indicated that the number of deaths of young adults (ranging from teenagers to people in their early thirties) was higher during the summer months, notably because they were more vulnerable to accidents or other deaths from external causes. In contrast, there were more deaths for seniors during the winter months, partially attributed to risks and disease associated with cold weather. This seasonal pattern of more deaths is especially evident when comparing the index of monthly deaths for 15 to 24 year olds and the senior population aged 85 years and over (Figure 4).
The increased mortality rate for men during their late teens and early twenties is a pattern which developed in the latter half of the last century. Comparing death ratios by age and sex for 1931, 1971 and 2007 (Figure 5) shows that while this increase is clear in both 1971 and 2007, it was not evident in 1931 when the death ratio was close to one for people in their late teens and early twenties (meaning that young men and women had similar probabilities of dying). In 1931 women actually had a higher probability of dying compared with men in their late twenties and thirties. This difference was mainly due to higher maternal mortality during this era given that these were prime childbearing years and women were more likely to die from complications related to childbearing than is currently the case.
Other than seniors, the population with the highest mortality rates are infants aged less than one. Babies under one year of age have a higher risk of death compared with the rest of childhood and most of young and middle adulthood. The number of infant deaths has been less than 2,000 per year in Canada since 1997. However, there were about 110 more deaths for babies during their first year in 2007 compared with 2006. This increase was due in large part to the higher number of births in 2007 than in the previous year (more than 13,200 additional births).
Overall, the infant mortality rate, or the number of deaths per 1,000 live births for infants under one year of age was 5.1 in 2007, marginally above the lowest recorded rate of 5.0 deaths per 1,000 live births in 2006 (Figure 6).
It is important, however, to distinguish between different subcategories of infant mortality given the patterns at which deaths occur for babies. Infants are most vulnerable during the initial days and weeks of their first year of life. Neonatal mortality refers to deaths of infants aged 0 to 27 days (with the subgroup of early neonatalmortality to indicate deaths for infants aged 0 to 6 days) while post-neonatal mortality refers to deaths of infants aged 28 to 364 days.
Improvements in infant mortality overall have been striking in the past century but gains have been slower for neonatal and early neonatal mortality. In both 2006 and 2007, more than eight in ten infant deaths were neonatal (more than six in ten infant deaths were early neonatal) and less than two in ten deaths occurred throughout the remainder of the first year. In 2007, the neonatal mortality rate for babies during the first month was 4.2 deaths per 1,000 live births while the early neonatal mortality rate during the first week was 3.3 deaths per 1,000 live births. Sex differences were apparent as the infant mortality rate for baby boys was 5.5 deaths per 1,000 live births while it was 4.7 per 1,000 live births for baby girls.
Given that the total number of infant deaths is relatively low, it can be difficult to generalize to provincial and territorial trends where small fluctuations in the number of births and/or deaths can lead to large differences in infant mortality rates from year to year. Overall, in 2007 infant mortality was higher than the national rate for Newfoundland and Labrador, Manitoba, Saskatchewan, Alberta, the Yukon and Nunavut. Recent research has found higher fetal and infant mortality in Inuit-inhabited areas in the Northwest Territories, Nunavut, northern Quebec and northern Labrador resulting from factors related to existing socio-economic, health and environment conditions.1 In contrast, infant mortality rates were below that of Canada for Nova Scotia, New Brunswick, Quebec, British Columbia and the Northwest Territories while the infant mortality rate was very near to the Canadian figure for the provinces of Prince Edward Island and Ontario. The patterns in 2006 were very similar although Quebec was much closer to the national rate than in 2007, the Northwest Territories was well above it and Prince Edward Island was below it.
The infant mortality rate in Canada is currently much lower than earlier in the 20th century and has been generally decreasing over the past 100 years. Although the infant mortality rate has been relatively low in the last several decades, it remains higher than many other industrialized countries (Figure 7). Internationally, there are many countries, particularly in Europe, with lower rates of infant mortality than that recorded in Canada.2 The infant mortality rate was 2.2 deaths per 1,000 live births in Sweden while it was 2.6 in Japan and Finland. Many other Organisation for Economic Co-operation and Development (OECD) countries also have infant mortality rates lower than Canada: United Kingdom (4.7), Australia (4.4), Switzerland (4.3), Netherlands (3.8), Austria (3.7), Italy and France (3.6), Germany and Ireland (3.5) and Denmark, Norway and Belgium (3.1). For the United States (6.4 deaths per 1,000 live births) the infant mortality rate was higher than for Canada.
Some of the variation in infant mortality rates across counties may be due to their definition of live births and reporting practices. Canada defines a live birth as a baby who is able to take a breath or shows other evidence of life.3 In many European countries there are also no gestational age or weight limits for registering a live birth. In some countries, however, there are differences, for example, in France and the Netherlands, live births have to be at least 500g or 22 weeks gestation.4 International variation in registration practices may have been less noticeable historically when overall infant mortality was much higher.5
Some other factors may help to explain why the infant mortality rate is higher in Canada. It may be partially explained by Canada's delivery of higher-risk preterm babies and/or babies with low birth weight. Babies weighing under 500 grams made up 18% of infant mortalities in Canada in 2007.6 Assisted reproductive technologies are associated with a greater chance of multiple births which in turn are more likely to be born pre-term and have a corresponding higher risk of death.7
According to age-specific mortality rates observed in 2007, a baby boy has a life expectancy of 78.5 years while a baby girl born this same year could expect to live 83.0 years, a gain of 0.3 years and 0.2 years for males and females, respectively, from the previous year (78.2 years for males born in 2006 and 82.8 years for females). Life expectancy at birth has been increasing for many years and while the sex differential is still evident there has been a narrowing in the gap between the sexes over the last three decades (Table 2).
At age 50 in 2007, men could expect to live an additional 30.9 years compared with 34.6 years for women. Interestingly, it was three decades earlier in 1977 that women's remaining life expectancy at age 50 paralleled that of their 2007 male counterparts. At age 65 in 2007 men could expect to live another 18.3 years while it was an additional 21.3 years for women. Even at age 80 in 2007 men could expect to live another 8.5 years and another 10.2 years for women.
In 2007, life expectancy at birth for both sexes combined was 80.8 years, up from 80.5 years in 2006. From one province to the next, there was not substantial variation in the life expectancy at birth. It was above the national average in British Columbia (81.3 years), Ontario (81.2 years) and Quebec (80.9 years) while life expectancy at birth in Alberta (80.6 years) was close to the national average. The remaining provinces and territories had life expectancies that were lower than Canada. Among the provinces, life expectancy at birth was lowest in Newfoundland and Labrador (78.4 years) and based on 2005 to 2007 data it was 75.8 years for the territories.9 In 2006, there was a similar provincial pattern as in 2007.
While Canada has one of the highest life expectancies at birth in an international context (both sexes), there were several OECD countries with even greater longevity according to recent data: Japan (83 years), Italy and Switzerland (82 years each). Life expectancy was similar to Canada in Norway, Iceland, Sweden, France, Australia and Spain. In the United States, life expectancy was 78 years, lower than in Canada. In contrast, many less industrialized nations have life expectancies that are similar to the level experienced in the industrialized countries in the early 19th century. Among the least industrialized countries, the average life expectancy at birth was 56 years and babies born in some African countries could only expect to live to their early forties. Lesotho, a country of about two million people in Southern Africa, had one of the lowest life expectancies at birth, 41 years, which was about half of that observed in Canada.10
- The The Inuvialuit region of the Northwest Territories, Nunavut, Nunavik (northern Quebec) and Nunatsiavut (northern coast of Labrador). Z.C. Luo, S. Senécal, F. Simonet, E. Guimond, C. Penney and R. Wilkins. 2010. "Birth outcomes in the Inuit-inhabited areas of Canada", Canadian Medical Association Journal, 182(2), pages 235 to 242.
- Population Reference Bureau. 2010. 2010 World Population Data Sheet, Washington, DC.
- Statistics Canada. 2011. Births 2008, catalogue no. 84F0210X.
- Euro-Peristat with SCPE, Eurocat, Euroneostat. 2008. European Perinatal Health Report.
- Conference Board of Canada. 2009. Health: Infant mortality, accessed May 27, 2010.
- Statistics Canada. Cansim Table 102-0030. Infant mortality, by sex and birth weight, Canada, provinces and territories, annual.
- Conference Board of Canada. 2009. Health: Infant mortality, accessed May 27, 2010.
- Life expectancy figures for 2007 are preliminary.
- Statistics Canada. 2010. Deaths 2007, catalogue no. 84F0211X.
- Population Reference Bureau. 2010. 2010 World Population Data Sheet. Washington, DC.