加拿大超额死亡人数直线上升, 与美国数字分道扬镳. 为什么?
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More people than expected are dying in Canada in 2023 for reasons that are not yet clear
WENCY LEUNGHEALTH REPORTERPUBLISHED AUGUST 15, 2023UPDATED FEBRUARY 5, 2024
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A nurse attends to a patient in the COVID-19 Intensive Care Unit at Surrey Memorial Hospital in Surrey on June 4, 2021.JONATHAN HAYWARD/THE CANADIAN PRESS
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COVID-19 case counts are down dramatically from a year ago, according to federal data. Hospitalizations are higher than during the first two pandemic summers, but are hovering around their lowest point since December, 2021. And there are now fewer than 30 COVID-19 deaths reported across the country per week.
But owing to limited testing and COVID-19 deaths that are undetected or not yet reported, the real toll COVID-19 continues to take on Canadians is not yet known.
By a different measure, one that is trickier to interpret, more people than expected are dying in Canada for reasons that are not yet clear. Excess mortality, also known as excess deaths, is a calculation of how many more deaths occur than are predicted based on demographic factors, including the growth and aging of the country’s population.
Estimated excess mortality dipped in January and February, but the latest 2023 figures indicate it is about 15 per cent to 20 per cent higher than it was in 2020 and 2021, according to Tara Moriarty, an infectious-disease researcher and co-founder of the grassroots group COVID-19 Resources Canada. That’s considerably lower than in 2022, “which was a horrific, really, really bad year in Canada, but it’s still higher than the first few years of the pandemic,” she said.
What excess mortality says about the current state of the pandemic is uncertain, in part because of a slow, patchwork system of reporting deaths in Canada. Yet it shouldn’t be ignored, said Dr. Moriarty, who is also an associate professor at the University of Toronto.
“We absolutely need to know why we have historically high levels of death,” she said.
A summer spike reminds us the pandemic isn’t over
Since the start of the pandemic until June, her group estimates there have been nearly 90,500 excess deaths in Canada, which is about double the number of Canadian deaths in the Second World War. That number is adjusted to subtract deaths from drug poisonings, suicides, mass homicide and a heat wave in B.C.
The total number of COVID-19 deaths that have been recorded since the start of the pandemic, however, stands at 53,216, according to Public Health Agency of Canada data.
In other countries such as Britain and France, which have timely death-reporting systems, almost all excess mortality can be explained by COVID-19 deaths, Dr. Moriarty said. The two numbers match up fairly closely to each other.
But in Canada, provinces lag in their reporting to the official Canadian Vital Statistics Database, which collects information, including cause of death, for all deaths in the country.
That reporting is not yet complete for the first year of the pandemic, Dr. Moriarty said. But so far, she said, most of the COVID-19 deaths that have been reported to the database for 2020 indicate about 90 per cent of excess deaths that year can probably be attributed to COVID-19.
In addition to those that are not yet reported, there are potentially many deaths caused by COVID-19 that are not detected or not officially attributed to the disease, she added. For example, if someone developed a serious health condition from an infection and died more than 28 days after testing positive, their death may not be considered a COVID-19 death in some jurisdictions.
Kim McGrail, a professor at the University of British Columbia’s Centre for Health Services and Policy Research, said she thinks of excess mortality as “an indication that there’s something happening that’s worth investigating,” but it doesn’t indicate what is actually happening or what to do about it.
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Similarly, in an e-mailed statement, Statistics Canada said unusual excess deaths don’t necessarily speak to COVID-19′s impact on Canada. Rather, they signal a need for deeper analysis.
Statistics Canada explained it uses a statistical model to estimate weekly expected deaths based on mortality trends from 2015-19 while considering changes in age, sex and total population.
Part of the problem, Dr. McGrail said, is there are many factors influencing mortality now that are different from before the pandemic. One wouldn’t try to predict deaths in 2023 based on looking at an average five-year period in the 1970s, for example, she said. To a similar but lesser extent, comparing mortality today with a model based on what it was before the pandemic is complicated by numerous factors, including the toxic drug crisis and other public-health crises, she said.
Beyond deaths directly caused by COVID-19, people can die from indirect or long-term effects of infection, or from the mental-health effects of the pandemic or because they had delays in getting medical treatment or surgeries for other kinds of illnesses, Dr. McGrail said.
But even if it turns out excess mortality is not being driven by COVID-19, Dr. Moriarty said the country still needs to address COVID-19, since it is not showing any signs it is going away, and will continue to limit people’s lifespans, put pressure on the health care system, potentially have long-term consequences for population health, including long COVID, and hurt economic productivity.
She added that Canada also needs to improve its death-reporting system to inform speedier responses to whatever crises may arise, whether it’s future pandemics or the effects of climate change.
Moreover, whatever is causing it, excess mortality is something the country should pay attention to, she said. “Because clearly there are a lot of people dying that wouldn’t normally have.”
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2023 年加拿大死亡人数将超过预期，但原因尚不明确
梁文施健康记者2023 年 8 月 15 日发布2024 年 2 月 5 日更新
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2021 年 6 月 4 日，一名护士在萨里郡萨里纪念医院的 COVID-19 重症监护室照顾一名患者。乔纳森·海沃德/加拿大新闻社
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根据联邦数据，新冠肺炎病例数较一年前大幅下降。住院人数高于前两个疫情夏季，但徘徊在 2021 年 12 月以来的最低点附近。目前， 全国每周报告的新冠肺炎死亡人数不足 30 人。
但由于检测有限，以及未被发现或尚未报告的 COVID-19 死亡病例，COVID-19对加拿大人造成的实际损失尚不清楚。
另一种更难解释的衡量标准是，加拿大的死亡人数比预期要多，原因尚不清楚。超额死亡率，也称为超额死亡，是根据人口因素（包括该国人口的增长和老龄化）计算出的死亡人数比预测的多。
传染病研究员、草根组织 COVID-19 Resources Canada 联合创始人塔拉·莫里亚蒂 (Tara Moriarty) 表示，1 月和 2 月估计的超额死亡率有所下降，但最新的 2023 年数据显示，超额死亡率比 2020 年和 2021 年高出约 15% 至 20%。这比 2022 年低得多，“2022 年对加拿大来说是可怕的、非常非常糟糕的一年，但仍高于疫情爆发的头几年，”她说。
超额死亡率对当前疫情状况的反映尚不确定，部分原因是 加拿大的死亡报告系统缓慢且不完整。但多伦多大学副教授莫里亚蒂博士表示，这一问题不应被忽视。
她说：“我们绝对需要知道为什么我们的死亡率达到历史最高水平。”
她的团队估计，自疫情爆发到今年 6 月，加拿大有近 90,500 人超额死亡，这大约是加拿大在二战期间死亡人数的两倍。该数字经过调整，扣除了药物中毒、自杀、大规模凶杀和不列颠哥伦比亚省热浪造成的死亡人数
然而，根据加拿大公共卫生署的数据，自疫情开始以来，记录的 COVID-19 死亡总数为 53,216 人。
莫里亚蒂博士说，在英国和法国等拥有及时死亡报告系统的其他国家，几乎所有超额死亡都可以用新冠肺炎死亡来解释。这两个数字相当接近。
但在加拿大，各省向官方的加拿大生命统计数据库报告情况滞后，该数据库收集了该国所有死亡的信息，包括死亡原因。
莫里亚蒂博士说，疫情第一年的报告尚未完成。但她说，到目前为止，2020 年已报告给数据库的大多数新冠肺炎死亡病例表明，当年约 90% 的超额死亡可能归因于新冠肺炎。
她补充说，除了尚未报告的病例外，可能还有许多死于 COVID-19 的病例未被发现或未被正式归因于该疾病。例如，如果某人因感染而出现严重的健康状况，并在检测呈阳性后超过 28 天死亡，则在某些司法管辖区，他们的死亡可能不被视为死于 COVID-19。
不列颠哥伦比亚大学卫生服务和政策研究中心教授金·麦克格雷尔表示，她认为超额死亡率“表明有一些事情正在发生，值得调查”，但它并不能表明到底发生了什么，或者该采取什么措施。
同样，加拿大统计局在一封电子邮件声明中表示，异常超额死亡并不一定说明 COVID-19 对加拿大的影响。相反，这表明需要进行更深入的分析。
加拿大统计局解释说，它使用统计模型根据2015-19年的死亡率趋势估算每周预期死亡人数，同时考虑年龄、性别和总人口的变化。
麦克格雷尔博士说，问题的部分原因在于，现在影响死亡率的因素有很多，与疫情之前不同。她说，例如，人们不会试图根据 1970 年代的平均五年期来预测 2023 年的死亡人数。她说，在类似但程度较轻的情况下，将今天的死亡率与基于疫情之前的死亡率模型进行比较，会受到许多因素的复杂影响，包括有毒药物危机和其他公共卫生危机。
麦克格雷尔博士说，除了直接由新冠肺炎造成的死亡外，人们还可能死于感染的间接或长期影响，或死于疫情对精神健康的影响，或因为延误获得其他疾病的治疗或手术。
但即使事实证明超额死亡不是由新冠肺炎造成的，莫里亚蒂博士表示，美国仍然需要应对新冠肺炎，因为目前还没有任何迹象表明它会消退，而且会继续限制人们的寿命，给医疗保健系统带来压力，可能对人口健康产生长期影响，包括长期新冠肺炎，并损害经济生产力。
她补充说，加拿大还需要改进死亡报告系统，以便对可能出现的任何危机做出更快的反应，无论是未来的流行病还是气候变化的影响。
此外，她表示，无论原因是什么，死亡率过高都是国家应该关注的问题。“因为显然有很多人死亡，而正常情况下不会有这么多人死亡。”
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More people than expected are dying in Canada in 2023 for reasons that are not yet clear
Limited testing and patchwork reporting systems may obscure the real toll of Covid-19 in Canada, says infectious disease researcher
www.theglobeandmail.com
这可是国家级猪妹. 加拿大死的人太多了. 怎么回事儿?
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老向这个也可能是个原因
加拿大安乐死人数大幅增长引起关注。
照片：GETTY IMAGES/ISTOCKPHOTO / IVAN-BALVAN
发布日期：2023年10月28日早上7点00分
加拿大卫生部本周公布的一份报告说，加拿大2022年的安乐死人数为13241人，比上一年增加了31.2%。这个增幅引起了一些专家的担忧。魁北克省卫生部将委托一个专家小组对安乐死申请的动机进行调研。
魁北克省2022年的安乐死人数比上一年增加了46%，为全国之最。安乐死在所有死因中所占比例在该省是6.6%，也超过了全国平均水平（4.1%）
也有专家认为不必对安乐死人数的逐年增加感到担忧。达尔豪斯大学法学院教授唐尼（Jocelyn Downie）说，当一件事从非法变成合法时，相关数据会出现增长，需要过一段时间才会趋于稳定。另外，如果接受安乐死的人患有无法治愈的严重疾病，那么数据增长并不是一件坏事。
在2022年接受安乐死的加拿大人当中，77.6%在接受临终关怀服务，其中近半数处于这种状态已经一个月以上。
这一年总共有3.5%的安乐死者并没有面临可以合理预期的死亡。该比例在2021年是2.2%。这也是一些专家担忧的原因。
自2016年安乐死在加拿大合法化以来，全国共有44958人接受了安乐死。法律规定，希望用这种方式离世的人必须身患引起极度痛苦的不治之症，或者有不断恶化、带来极度痛苦的严重残疾，其申请方可获批。不过从明年3月17日起，这个范围将被扩大到精神病。
除魁北克省外，去年安乐死增幅超过全国平均水平的省份还有阿尔伯塔省（41%）和纽芬兰省（38%）
加拿大安乐死人数大幅增长引起关注。
照片：GETTY IMAGES/ISTOCKPHOTO / IVAN-BALVAN
发布日期：2023年10月28日早上7点00分
加拿大卫生部本周公布的一份报告说，加拿大2022年的安乐死人数为13241人，比上一年增加了31.2%。这个增幅引起了一些专家的担忧。魁北克省卫生部将委托一个专家小组对安乐死申请的动机进行调研。
魁北克省2022年的安乐死人数比上一年增加了46%，为全国之最。安乐死在所有死因中所占比例在该省是6.6%，也超过了全国平均水平（4.1%）
也有专家认为不必对安乐死人数的逐年增加感到担忧。达尔豪斯大学法学院教授唐尼（Jocelyn Downie）说，当一件事从非法变成合法时，相关数据会出现增长，需要过一段时间才会趋于稳定。另外，如果接受安乐死的人患有无法治愈的严重疾病，那么数据增长并不是一件坏事。
在2022年接受安乐死的加拿大人当中，77.6%在接受临终关怀服务，其中近半数处于这种状态已经一个月以上。
这一年总共有3.5%的安乐死者并没有面临可以合理预期的死亡。该比例在2021年是2.2%。这也是一些专家担忧的原因。
自2016年安乐死在加拿大合法化以来，全国共有44958人接受了安乐死。法律规定，希望用这种方式离世的人必须身患引起极度痛苦的不治之症，或者有不断恶化、带来极度痛苦的严重残疾，其申请方可获批。不过从明年3月17日起，这个范围将被扩大到精神病。
除魁北克省外，去年安乐死增幅超过全国平均水平的省份还有阿尔伯塔省（41%）和纽芬兰省（38%）
