Evidence map›Paper›PMID 39349735›Full record

ArticleCanadian journal of public health = Revue canadienne de sante publique2025

Rising out-of-hospital mortality in Canada during 2020‒2022: A striking impact observed among young adults.

Mukesh Kumar, Jessalyn K Holodinsky, Amy Y X Yu, Candace D McNaughton, Peter C Austin, Anna Chu, Michael D Hill, Colleen Norris, Douglas S Lee, Moira K Kapral and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Canadian journal of public health = Revue canadienne de sante publique, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. The acuity of paediatric asthma in the emergency department worsened after the COVID-19 pandemic in Alberta, Canada.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Mukesh KumarDepartment of Industrial Engineering, Dalhousie University, Halifax, NS, Canada. mukesh.kumar@dal.ca.ORCID 0000-0001-8426-4844
Jessalyn K HolodinskyDepartment of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Amy Y X YuDepartment of Medicine, University of Toronto, Toronto, ON, Canada.
Candace D McNaughtonDepartment of Medicine, University of Toronto, Toronto, ON, Canada.
Peter C AustinICES, Toronto, ON, Canada.
Anna ChuICES, Toronto, ON, Canada.
Michael D HillDepartment of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Colleen NorrisFaculty of Nursing, University of Alberta, Edmonton, AB, Canada.
Douglas S LeeDepartment of Medicine, University of Toronto, Toronto, ON, Canada.
Moira K KapralDepartment of Medicine, University of Toronto, Toronto, ON, Canada.
Nadia KhanCenter for Advancing Health Outcomes, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Noreen KamalDepartment of Industrial Engineering, Dalhousie University, Halifax, NS, Canada.

Funding

CIHR 179897
6 · The paper itself

Abstract

objectiveOut-of-hospital mortality rates surged during the early COVID-19 pandemic. While expecting a return to pre-pandemic levels, the evolving patterns of out-of-hospital mortality in Canada remain uncertain. We investigated whether these rates returned to pre-pandemic levels.

methodsThis retrospective study, employing linked administrative data, analyzed out-of-hospital mortality trends among adult residents in Ontario, Alberta, and Nova Scotia. Interrupted time series analysis assessed trends in age- and sex-standardized rates/100,000/quarter during pre-pandemic (April 2014-March 2020) and pandemic periods (April 2020-March 2022), while considering April to June 2020 as the pandemic onset period. Crude mortality rates were also examined, stratified by sex and age groups.

resultsPre-pandemic, Ontario's standardized out-of-hospital mortality rates were rising, while Alberta's and Nova Scotia's remained stable. At the pandemic onset, all provinces experienced significant increases in standardized out-of-hospital mortality rates/100,000 (Ontario: β 14.6, 95% CI [3.97, 25.22]; Alberta: 21.3, 95% CI [9.26, 33.34]; Nova Scotia: 10.5, 95% CI [1.06, 19.88]). During the pandemic, standardized out-of-hospital mortality rates/100,000/quarter remained above pre-pandemic levels, with no significant departure from the increased pandemic onset levels (Ontario: - 1.6, 95% CI [- 3.63, 0.52]; Alberta: 0.45, 95% CI [- 1.47, 2.36]; Nova Scotia: - 0.06, 95% CI [- 2.18, 2.06]). Crude out-of-hospital mortality rates increased most prominently among individuals aged 18 to 45 in Alberta and Ontario, and among males across all provinces.

conclusionThe sustained increase in out-of-hospital mortality, observed from the pandemic's onset, spanning more than 2 years, potentially suggests its persistent direct and indirect effects on population health in Canada.

Indexed as

COVID-19MortalityPandemicsAdolescentAdultAgedAged, 80 and overAge DistributionAlbertaFemaleHumansInterrupted Time Series AnalysisMaleMiddle AgedNova ScotiaOntarioAll-setting mortalityCanadian provincesCOVID-19Crude mortalityOut-of-hospital mortalityPublic healthStandardized mortality

Identifiers

PMID39349735
PMCPMC11870715

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.