Temporal trends in leading causes of injury deaths in Canada from 2000 to 2023: a time series analysis of mortality data.

BACKGROUND: Understanding long-term trends in causes of injury mortality is essential for informing prevention strategies and public health priorities. In Canada, most studies focused on individual causes of injury deaths, with limited examination of how leading causes evolved collectively over time. This study aimed to assess trends in leading causes of injury mortality and changes in the rankings of leading causes in Canada from 2000 to 2023, overall and by sex and age group. METHODS: Mortality data were obtained from the Canadian Vital Statistics - Death database, Canadian Coroner and Medical Examiner Database and provincial/territorial chief coroner or chief medical examiner offices. Leading causes of injury deaths were ranked based on their annual crude mortality rates. A joinpoint regression model was applied to quantify trends by annual percent change of age-standardized or crude mortality rates for each leading cause with stratification by sex and age group. RESULTS: Falls, poisonings, suicide and land transport incidents were consistently the top four leading causes of injury deaths for both males and females during the study period, although their relative rankings and trends varied by sex. Age groups had different leading cause rankings and trends. Overall, age-standardized mortality rate (ASMR) increased annually for poisonings (9.2%) and falls (4.6%), while ASMR for land transport incidents had an annual decline of 3.1%. ASMR also decreased annually for struck by/against (2.1%), smoke/fire/flame (2.0%), homicide (1.7%) and drowning (0.8%). Compared with males, females experienced a faster increase in fall-related mortality and a steeper decline in land transport incident-related deaths. Females had an annual increase of 0.8% in the suicide ASMR. Crude mortality rate for poisonings increased annually among 10-79-years-olds (6.5%-9.3%), while fall-related mortality increased among those 45 years and older (1.7%-5.7% annually) but declined among those under 45 years (1.1%-4.8% annually). CONCLUSIONS: The profile of injury mortality in Canada has shifted over the past two decades, highlighting the need for targeted injury prevention strategies that address the growing burden of falls and poisonings while sustaining progress in declining causes. Continuous data collection and research are important for injury surveillance and prevention.