An analysis of mortality in Ontario using cremation data: Rise in cremations during the COVID-19 pandemic

Background The impact of coronavirus disease 2019 (COVID-19) on mortality in Ontario is unknown. Cremations are performed for most deaths in Ontario and require coroner certification before the cremation can take place. Our objective was to provide timely analysis of deaths during the COVID-19 pandemic using cremation data. Methods We analyze cremation certificate data from January 1, 2017, to June 30, 2020, in Ontario. 2020 cremation records were compared to historical records from 2017-2019 by age, month, and place of death and COVID-19 status. A time series model was fit to quantify the deviation in cremation trends during the COVID-19 period. Results There have been 39 760 cremations in Ontario in 2020 with the highest number of seen in April (N = 7 527 cremations) when peak COVID-19 cases were seen. Over the study period, the proportion of cremations from deaths in hospitals decreased whereas cremations from long-term care and residences increased. In April there were 1 839 more cremations compared to historical averages over 2017-2019, representing a 32% increase. Time series modelling of cremations from January 2017 demonstrated that cremations in April and May 2020 exceeded the projections based on modelled estimates. Conclusion We demonstrate the utility of cremation data for providing timely mortality information during a public health emergency. Cremations were higher in the pandemic months compared to previous years, and there was a shift in deaths occurring in hospitals to long-term care and residences. These timely estimates of mortality are critical for understanding the impact of COVID-19.