Provincial and Territorial Ranking
Mortality Due to Respiratory Diseases
- Ontario and B.C. have the lowest rates of respiratory deaths in the country, and score “B” grades.
- The territories finish at the bottom of the rankings, with deaths from respiratory disease in Nunavut nearly five times the Canadian average.
- Prevalence of chronic obstructive pulmonary disease, a leading respiratory disease, is highest in the Maritimes and Quebec.
Putting mortality due to respiratory disease in context
Respiratory diseases include chronic obstructive pulmonary disease (COPD), asthma, tuberculosis, bronchiolitis, emphysema, cystic fibrosis, influenza, and pneumonia. Although Canada and most of its peer countries have seen a decrease in respiratory diseases over the past few decades, aging populations in developed countries are expected to lead to a surge in these diseases in the future.
How does respiratory disease affect the quality of life of Canadians?
Over 3 million Canadians of all ages have a serious respiratory disease such as asthma, COPD, lung cancer, tuberculosis (TB), cystic fibrosis, and respiratory distress syndrome. The numbers are likely much higher, however, given that data are unavailable for other respiratory conditions such as influenza, pneumonia, and bronchiolitis.1 After cardiovascular disease and cancer, respiratory diseases are responsible for the third highest share of hospitalizations and deaths in Canada.2
Smoking is the main preventable risk factor for respiratory diseases like lung cancer and COPD. Fortunately, the proportion of smokers has dropped significantly in the past several decades. In the last decade alone, the proportion of daily smokers fell from 17.9 per cent to 14.2 per cent in Canada.3
Although the proportion of smokers has dropped, Canada, like many of its peer countries, is facing an increase in chronic respiratory diseases. As a report published by Health Canada explains, "since many of these diseases affect adults over the age of 65, the number of people with respiratory diseases will increase as the population ages. The corresponding increase in demand for services will pose a significant challenge for the health care system.”4
How do the provinces and territories rank relative to Canada’s international peers?
In the provinces, mortality due to respiratory disease is lowest in Ontario, where 58 deaths per 100,000 population earns the province a “B” grade, behind seven of Canada’s international peers. However, B.C. is close behind and also scores a “B” with an average of 60.3 deaths per 100,000 population between 2009 and 2011. Finland—the top performer—had 32.9 deaths per 100,000 due to respiratory disease.
Overall, Canada scores a “B” grade and ranks 8th among 16 peer countries, with an average of 63.1 deaths per 100,000 population due to respiratory disease between 2009 and 2011. All the other provinces rank below the Canadian average. P.E.I., the worst-ranking province, scores a “C” grade with a three-year average of 80 deaths per 100,000 population due to respiratory disease, placing ahead of six of Canada’s international peers.
The territories rank at the bottom of the pack with the highest mortality rates due to respiratory diseases. Yukon and N.W.T. earn “D” grades. Nunavut scores a “D-” grade, with an average mortality rate almost three times higher than that of the worst-ranked peer country, the United Kingdom.
How do the provinces and territories perform relative to each other?
Ontario and B.C. are the top-ranking provinces on mortality due to respiratory disease and score “B” grades. P.E.I. and Nova Scotia are the bottom-ranked provinces and score “C” grades. The territories have the highest respiratory disease mortality rates in Canada. Although the rates of mortality from respiratory disease do not differ much between provinces, there is a large discrepancy between the provinces and territories. In fact, mortality rates from respiratory disease in Nunavut are almost four times greater than in P.E.I., the worst-ranked province.
Why is mortality from respiratory disease high in the Atlantic provinces?
Risk factors for respiratory disease include tobacco consumption and exposure to second-hand smoke, poor living conditions, and poor diet. Smoking rates in the Atlantic provinces are considerably higher than the Canadian average of 14.9 per cent between 2011 and 2013. In fact, on average, more than 17 per cent of the population aged 12 and over smoked daily between 2011 and 2013 in all four provinces. On top of that, residents of these four provinces are more exposed to second-hand smoke.5 Living conditions are also likely worse for a greater share of the population in these provinces, as the share of the population aged 18 to 64 earning low incomes in Newfoundland and Labrador, Nova Scotia, and New Brunswick is greater than the Canadian average of 14.4 per cent.6
Why is mortality from respiratory disease in the territories so high?
While mortality from respiratory disease is high in Yukon and N.W.T.—on average, 100.5 and 103.1 people died per 100,000 population between 2009 and 2011, respectively—it is off the charts in Nunavut. About 303.3 people died per 100,000 population in Nunavut between 2009 and 2011, almost five times more than the Canadian average.
The primary reason for the higher mortality rates in the territories is poorer living conditions, especially for Aboriginal people. Higher rates of poverty, overcrowded homes, and a greater proportion of homes in need of major repairs all contribute to respiratory issues in the territories.7 In the worst-performing territory—Nunavut—the difference in living conditions with the rest of the country is clear. About 27.7 per cent of all homes in Nunavut are in need of major repair, compared with only 7.3 per cent at the national level. In addition, around 30.5 per cent of households in Nunavut are considered “unsuitable,” while the corresponding rate for Canada is only 6 per cent. Finally, 18.7 per cent of households in Nunavut contain more than one person per room, compared with a mere 2 per cent for Canada as a whole.8
The higher smoking rates in the territories also contribute to the higher mortality due to respiratory diseases.9 Close to 50 per cent of Nunavut residents over the age of 12 smoke daily, compared with 14.2 per cent for Canada as a whole.10 And when exposure to second-hand smoke is taken into account, the risk to Nunavut residents is even greater. About 28.5 per cent Nunavut’s population is exposed to second-hand smoke at home or in public places. The corresponding rate in N.W.T. is 34.1 per cent. This compares with 20.5 per cent at the national level.11
Which respiratory diseases place the heaviest burden on the Canadian health care system?
The top two leading respiratory diseases contributing to the overall Canadian respiratory disease burden are asthma and chronic obstructive pulmonary disease (COPD).
Asthma is now the most common of all respiratory diseases in Canada, with about 2.4 million cases. More than 830,000 Canadians are believed to be living with COPD.12 COPD and asthma account for over 50 per cent of respiratory system deaths in Canada.13
How do the provinces and territories rank relative to one another on COPD prevalence?
Not surprisingly, the rankings for COPD prevalence are similar to the overall rankings for respiratory disease deaths. There is not much difference at the top—Ontario, B.C., and Manitoba, which have the lowest mortality rates due to respiratory disease, also have the lowest COPD prevalence. In each of the three provinces, an average of only 3.7 per cent of the population aged 12 and above suffered from COPD between 2011 and 2013. The next five provinces and Yukon do almost as well as Ontario, with sixth-placed Alberta coming in at an average of 3.9 per cent. The provinces with the highest COPD prevalence rates—P.E.I., Nova Scotia, and New Brunswick—all have high mortality rates due to respiratory diseases. Unfortunately, data for N.W.T. are sporadic, although the last recorded rate of COPD prevalence was 3.6 per cent in 2012 (there is not enough history to compare N.W.T.’s three-year average rate of COPD prevalence with the rest of the country). No data are available for Nunavut.
While there are several factors that lead to COPD, the main cause is tobacco smoke. Therefore, reducing smoking rates should lower the prevalence of COPD. However, as smoking rates have declined in Canada, the prevalence of COPD has basically remained the same. In 2003, 4.3 per cent of the population suffered from COPD. By 2013, that rate had dropped slightly to 4 per cent. It may be a while before the decline in smoking rates is reflected in lower COPD prevalence.
COPD is more prevalent in the elderly. Among Canadians 65 years and older, the number suffering from COPD went up by 39 per cent between 2003 and 2013. However, even in the 45 to 64 cohort, there was a 15 per cent increase in COPD cases. And what is interesting is that more women have this disease than men.14 Some of this can be explained by the lag in the decline of tobacco use among women relative to men, leading to more COPD cases as those women aged. Tobacco consumption by men started to fall in the 1960s whereas tobacco consumption by women did not begin to drop until the 1980s in Canada.15