{"id":1408,"date":"2023-04-07T09:45:55","date_gmt":"2023-04-07T13:45:55","guid":{"rendered":"https:\/\/carleton.ca\/determinants\/?p=1408"},"modified":"2025-04-29T10:04:48","modified_gmt":"2025-04-29T14:04:48","slug":"deaths-from-covid-19-in-canada-a-multiple-cause-of-death-approach","status":"publish","type":"post","link":"https:\/\/carleton.ca\/determinants\/2023\/deaths-from-covid-19-in-canada-a-multiple-cause-of-death-approach\/","title":{"rendered":"Deaths from COVID-19 in Canada: a multiple cause of death approach"},"content":{"rendered":"\n<section class=\"w-screen px-6 cu-section cu-section--white ml-offset-center md:px-8 lg:px-14\">\n    <div class=\"space-y-6 cu-max-w-child-5xl  md:space-y-10 cu-prose-first-last\">\n\n            <div class=\"cu-textmedia flex flex-col lg:flex-row mx-auto gap-6 md:gap-10 my-6 md:my-12 first:mt-0 max-w-5xl\">\n        <div class=\"justify-start cu-textmedia-content cu-prose-first-last\" style=\"flex: 0 0 100%;\">\n            <header class=\"font-light prose-xl cu-pageheader md:prose-2xl cu-component-updated cu-prose-first-last\">\n                                    <h1 class=\"cu-prose-first-last font-semibold !mt-2 mb-4 md:mb-6 relative after:absolute after:h-px after:bottom-0 after:bg-cu-red after:left-px text-3xl md:text-4xl lg:text-5xl lg:leading-[3.5rem] pb-5 after:w-10 text-cu-black-700 not-prose\">\n                        Deaths from COVID-19 in Canada: a multiple cause of death approach\n                    <\/h1>\n                \n                                \n                            <\/header>\n\n                    <\/div>\n\n            <\/div>\n\n    <\/div>\n<\/section>\n\n<h3 id=\"poster-images\" class=\"wp-block-heading\">Poster Images<\/h3>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"240\" height=\"325\" src=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide1-240x325.png\" alt=\"\" class=\"wp-image-1410\" srcset=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide1-240x325.png 240w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide1-160x216.png 160w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide1-400x541.png 400w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide1-360x487.png 360w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide1.png 720w\" sizes=\"auto, (max-width: 240px) 100vw, 240px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide2.png\"><img loading=\"lazy\" decoding=\"async\" width=\"240\" height=\"325\" src=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide2-240x325.png\" alt=\"\" class=\"wp-image-1411\" srcset=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide2-240x325.png 240w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide2-160x216.png 160w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide2-400x541.png 400w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide2-360x487.png 360w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide2.png 720w\" sizes=\"auto, (max-width: 240px) 100vw, 240px\" \/><\/a><\/figure>\n\n\n\n<p><a href=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Slide1.png\"> <\/a><\/p>\n\n\n\n<h3 id=\"covid-19-deaths-in-canada\" class=\"wp-block-heading\">COVID-19 Deaths in Canada<\/h3>\n\n\n\n<p>Authors: Michel Lopez Barrios, Tomoko McGaughey, Morgan Klym, and Paul Peters<\/p>\n\n\n\n<p>Presented at: Population Association of America Conference, April 13, 2023.<\/p>\n\n\n\n<p>The analysis of COVID-19 mortality using a single cause represents a significant limitation to understanding the disease. In this study, the relationship between the underlying cause of COVID-19 with its comorbidities provides important inputs for future comparisons.<\/p>\n\n\n\n<p><iframe loading=\"lazy\" id=\"can-mort-cnts\" style=\"border: none;\" src=\"https:\/\/chart-studio.plotly.com\/~paulpeters\/5.embed\" width=\"100%\" height=\"525\" scrolling=\"no\" seamless=\"seamless\"><\/iframe><\/p>\n\n\n\n<p>COVID-19 has driven higher mortality since March 2020, resulting in an increasingly large cumulative increase of deaths. Since October 2021, COVID-19 as a contributing factor to excess deaths has decreased. In the first year of the pandemic, COVID-19 was coded largely as the underlying cause (UC) of death. After the 1st year, COVID-19 was increasingly coded as a contributing cause (CC) of death.<\/p>\n\n\n\n<h3 id=\"covid-19-and-contributing-causes\" class=\"wp-block-heading\">COVID-19 and Contributing Causes<\/h3>\n\n\n\n<p>We compared COVID-19 deaths from 2020 (Alpha) to 2021 (Beta, Delta &amp; Gamma variants). For deaths where the UC was COVID-19, the mean number of CCs increased between 2020 and 2021. The increase in mean number of CCs was seen across the age groups and for both sexes.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/mean_num_causes.png\"><img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"276\" src=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/mean_num_causes-400x276.png\" alt=\"\" class=\"wp-image-1414\" srcset=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/mean_num_causes-400x276.png 400w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/mean_num_causes-160x110.png 160w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/mean_num_causes-240x165.png 240w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/mean_num_causes-768x529.png 768w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/mean_num_causes-1536x1059.png 1536w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/mean_num_causes-2048x1411.png 2048w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/mean_num_causes-360x248.png 360w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<p>Explanations may include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A shift in who died from COVID-19<\/li>\n\n\n\n<li>A shift in coding practices<\/li>\n\n\n\n<li>Differing impact of COVID-19 strains over the pandemic<\/li>\n<\/ul>\n\n\n\n<p>Next steps include examining deaths linked to hospital discharge abstracts to better ascertain reasons for the increase.<\/p>\n\n\n\n<h3 id=\"covid-19-and-coding-mortality\" class=\"wp-block-heading\">COVID-19 and Coding Mortality<\/h3>\n\n\n\n<p>The Standardized Ratio of Multiple to Underlying Causes is the age-standardised rate for any mention compared to the age-standardised rate when the cause is the UC.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&lt;2 indicates the cause more often a UC<\/li>\n\n\n\n<li>2 indicates equal representation as UC &amp; CC<\/li>\n\n\n\n<li>2 indicates the cause is more often a CC<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.53.26-PM.png\"><img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"167\" src=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.53.26-PM-400x167.png\" alt=\"\" class=\"wp-image-1415\" srcset=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.53.26-PM-400x167.png 400w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.53.26-PM-160x67.png 160w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.53.26-PM-240x100.png 240w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.53.26-PM-768x321.png 768w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.53.26-PM-1536x641.png 1536w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.53.26-PM-2048x855.png 2048w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.53.26-PM-360x150.png 360w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<h3 id=\"marginal-change\" class=\"wp-block-heading\">Marginal Change<\/h3>\n\n\n\n<p>We used Poisson regression to estimate the marginal change in the average number of CCs for each group of UCs<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The mean number of CCs was higher for all causes in 2021 (3.33), possibly because of excess of mortality in 2020 (3.26).<\/li>\n\n\n\n<li>Females had a lower mean number of CC (3.25) than males (3.34)<\/li>\n\n\n\n<li>COVID-19 has a lower mean number of contributing causes (3.48) compared to other infectious diseases (3.50)<\/li>\n\n\n\n<li><strong>The mean contributing causes of death when COVID-19 was a UC increased from 3.48 in 2020 to 3.67 in 2021<\/strong><\/li>\n\n\n\n<li>The mean number of CCs was lowest for single individuals (3.23) compared to married (3.28)<\/li>\n\n\n\n<li>Those from low-income areas had higher mean number of CC (3.33) compared to those in the highest income areas (3.19)<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/change_num_causes.png\"><img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"278\" src=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/change_num_causes-400x278.png\" alt=\"\" class=\"wp-image-1416\" srcset=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/change_num_causes-400x278.png 400w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/change_num_causes-160x111.png 160w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/change_num_causes-240x167.png 240w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/change_num_causes-768x535.png 768w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/change_num_causes-1536x1069.png 1536w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/change_num_causes-2048x1426.png 2048w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/change_num_causes-360x251.png 360w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<h3 id=\"changes-in-covid-19-coding\" class=\"wp-block-heading\">Changes in COVID-19 Coding<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Large increase in coding of COVID-19 as a contributing cause between 2020 and 2021 in Ontario, Alberta, and British Columbia.<\/li>\n\n\n\n<li>Small decrease in coding of COVID-19 as a contributing cause between 2020 and 2021 in Quebec.<\/li>\n\n\n\n<li>Public health measures carried out in Canada have not only reduced the mortality associated with COVID-19 as an UC but have also\u00a0changed the structure of associated causes.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.57.51-PM.png\"><img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"147\" src=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.57.51-PM-400x147.png\" alt=\"\" class=\"wp-image-1417\" srcset=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.57.51-PM-400x147.png 400w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.57.51-PM-160x59.png 160w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.57.51-PM-240x88.png 240w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.57.51-PM-768x283.png 768w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.57.51-PM-1536x566.png 1536w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.57.51-PM-360x133.png 360w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.57.51-PM.png 1980w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.58.21-PM.png\"><img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"597\" src=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.58.21-PM-400x597.png\" alt=\"\" class=\"wp-image-1418\" srcset=\"https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.58.21-PM-400x597.png 400w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.58.21-PM-160x239.png 160w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.58.21-PM-240x358.png 240w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.58.21-PM-768x1146.png 768w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.58.21-PM-360x537.png 360w, https:\/\/carleton.ca\/determinants\/wp-content\/uploads\/sites\/79\/Screenshot-2023-04-13-at-2.58.21-PM.png 988w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<h3 id=\"data-sources\" class=\"wp-block-heading\">Data Sources<\/h3>\n\n\n\n<p>We accessed the Canadian Vital Statistics Death Database and Multiple Cause Database through Statistics Canada\u2019s Research Data Centre (RDC). Data accessed through the RDC, which follows strict disclosure protocols in accordance with the Statistics Acts, is exempt from approval by the Research Ethics Board (REB) as per Tri-Council Policy Statement: Ethical conduct for research involving humans (TCPS2) article 2.2 (a).<\/p>\n\n\n\n<h3 id=\"funding-sources\" class=\"wp-block-heading\">Funding Sources<\/h3>\n\n\n\n<p>Funding for this research was provided by Social Sciences and Humanities Research Council of Canada Insight Grant #435-2021-1052.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Poster Images COVID-19 Deaths in Canada Authors: Michel Lopez Barrios, Tomoko McGaughey, Morgan Klym, and Paul Peters Presented at: Population Association of America Conference, April 13, 2023. The analysis of COVID-19 mortality using a single cause represents a significant limitation to understanding the disease. In this study, the relationship between the underlying cause of COVID-19 [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"categories":[120,26],"tags":[],"class_list":["post-1408","post","type-post","status-publish","format-standard","hentry","category-multiple-cause-of-death","category-population-studies"],"acf":{"cu_post_thumbnail":"ottawa-canal"},"_links":{"self":[{"href":"https:\/\/carleton.ca\/determinants\/wp-json\/wp\/v2\/posts\/1408","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/carleton.ca\/determinants\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/carleton.ca\/determinants\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/carleton.ca\/determinants\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/carleton.ca\/determinants\/wp-json\/wp\/v2\/comments?post=1408"}],"version-history":[{"count":3,"href":"https:\/\/carleton.ca\/determinants\/wp-json\/wp\/v2\/posts\/1408\/revisions"}],"predecessor-version":[{"id":1419,"href":"https:\/\/carleton.ca\/determinants\/wp-json\/wp\/v2\/posts\/1408\/revisions\/1419"}],"wp:attachment":[{"href":"https:\/\/carleton.ca\/determinants\/wp-json\/wp\/v2\/media?parent=1408"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/carleton.ca\/determinants\/wp-json\/wp\/v2\/categories?post=1408"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/carleton.ca\/determinants\/wp-json\/wp\/v2\/tags?post=1408"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}