How did we die in 2020 – Canada versus the United States

By Peter Gorham, FCIA, Actuary, JDM Actuarial Expert Services

Canada defeated the United States in World Cup qualifying this past weekend while I spent my time looking at the 2020 causes of death in the two countries.

Statistics Canada released the data on causes of death for 2000 to 2020 this past week. Similarly, the Society of Actuaries (SOA) released a research paper looking at US population mortality and causes of death in 2020. There are some significant differences.

In the following table, I show a comparison based on the 10 major causes of death in the US. I have added three other causes of death in Canada that were not highlighted in the SOA research paper but resulted in more deaths than hypertension.

The order of these causes is similar between the countries with notable exceptions:

1. “Cancer” and “Heart Disease” are reversed, with cancer responsible for over a quarter of Canadian deaths and less than a fifth of American deaths. Heart disease was the number one killer in the US with the percentage of all deaths similar to that in Canada.
2. Other diseases kill a greater percentage of Canadians – this is especially notable since the US percentage for “Other” includes the causes of death attributed to “Kidney,” “Parkinson’s,” and “sepsis,” all of which are separated in the Canadian numbers. If those deaths are included under “Other,” the Canadian percentage would be 26.7% compared with 18.9% for the US.
3. “Alzheimer’s/Dementia” is responsible for hugely different percentages of deaths – Americans were four times more likely to die from this in 2020 than Canadians.
4. Americans were twice as likely to die from “Hypertension” and about seven times as likely to die from “Assault” compared to Canadians.

Why such differences? Is it lifestyle, access to or affordability of health care, quality of health care, education, socio-economic differences? The answer is beyond my expertise, but your thoughts about this are welcome in the comments.

There are also some big differences in mortality improvement.

1. The worsening of accident mortality was almost six times greater in the US (Accidental death includes death by opioids and other drugs). But the 2022 changes look like they are hiding a longer-term trend where, in Canada, accident mortality has worsened by 23% over the past five years. The SOA report split the analysis between “Accidents Excluding Opioids” (2.0% worsening) and “Opioids” (15.3% worsening).
2. Over the past 20 years, diabetes mortality has been generally improving in both countries, but 2020 saw both Canadian and US mortality from diabetes worsen – significantly so in the US.
3. Canadian health authorities commented that the 2020 flu season saw few cases, likely because of lockdowns and mask-wearing. Mortality from flu and pneumonia improved a lot as a result. The US response to COVID-19 was very different from the Canadian response, and presumably, that explains the big difference between the countries. It is also possible that some COVID-19 deaths may have been attributed to the flu or pneumonia with a different effect by country.
4. Alzheimer’s and dementia have seen a steady improvement in mortality over the past year as well as the past 20 years in Canada. In 2020, the US mortality worsened (no longer-term data available).
5. Mortality from hypertension has been steadily worsening in both countries over the past 20 years (numbers not provided for the US – Canadian mortality worsened by 50% over 20 years and 21% over the past five years).
6. While the Canadian mortality from assault has improved (and it has been improving over the past 20 years), the US mortality has worsened (numbers not provided for the US).

I note that the Canadian data seems to show an inconsistency. The overall mortality rate for Canadians in 2020 was 808 per 100,000 – 0.81%. Removing the effect of COVID-19, the 2020 Canadian mortality rate was 766 per 100,000 – compared to 760 in 2019. That is a slight worsening in overall mortality in Canada in 2020.

But based on the 2020 Canada life tables just released by Statistics Canada, the 2020 Canadian mortality adjusted to remove COVID-19 had a slight improvement over 2019. Excluding COVID-19, the cause of death data showed a 1% worsening while the life tables showed a 0.5% improvement for 2020.

There have been discrepancies like that over the past 20 years. The cause of death data shows overall Canadian mortality rates worsening by 8% over the past 20 years, while the Canada life tables show an improvement of 29%. Your insights and hypotheses are welcomed in the comments.

We must remember that these numbers are only as good as the cause of death that is given. The cause of death can, in some situations, be subjective and may be influenced by outside considerations.

This article only scratches the surface of the cause of death. In particular, I did not attempt to obtain more details of US deaths but referred only to what was included in the SOA research report.

The causes of death for Canada 2000 to 2020 can be found at Statistics Canada: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401

The SOA research paper U.S. Population Mortality Observations can be found at the SOA: https://www.soa.org/resources/research-reports/2022/us-population-mortality/

This article reflects the opinion of the author and does not represent an official statement of the CIA.