Epidemiology and Infection

Research Article

Influenza-attributable deaths, Canada 1990–1999

D. L. SCHANZERa1 c1, T. W. S. TAMa1, J. M. LANGLEYa2 and B. T. WINCHESTERa1

a1 Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada

a2 Clinical Trials Research Center, IWK Health Center and Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada


The number of deaths attributable to influenza is believed to be considerably higher than the number certified by vital statistics registration as due to influenza. Weekly mortality data for Canada from the 1989/1990 to the 1998/1999 influenza seasons were analysed by cause of death, age group, and place of death to estimate the impact of influenza on mortality. A Poisson regression model was found to accurately predict all-cause, as well as cause-specific mortality, as a function of influenza-certified deaths, after controlling for seasonality, and trend. Influenza-attributable deaths were calculated as predicted less baseline-predicted deaths. In summary, throughout the 1990s there were on average just under 4000 deaths attributable to influenza annually (for an influenza-attributable mortality rate of 13/100 000 persons), varying from no detectable excess mortality for the 1990/1991 influenza season, to 6000–8000 influenza-attributable deaths for the more severe influenza seasons of 1997/1998 and 1998/1999. On average, 8% (95% CI 7–10) of influenza-attributable deaths were certified as influenza, although this percentage varied from 4% to 12% from year to year. Only 15% of the influenza-attributable deaths were certified as pneumonia, and for all respiratory causes, 40%. Deaths were distributed over most causes. The weekly pattern of influenza-certified deaths was a good predictor of excess all-cause mortality.

(Accepted November 30 2006)

(Online publication February 19 2007)


c1 Author for correspondence: Ms. Dena Schanzer, Modelling and Projection Section, Surveillance and Risk Assessment Division, Center for Infectious Disease Prevention and Control, Public Health Agency of Canada, LCDC Building, 100 Eglantine Driveway, Tunney's Pasture, AL 0602B, Ottawa, Ontario, Canada, K1A 0K9. (Email: dena_schanzer@phac-aspc.gc.ca)