Economic Insights
Employment and Social Assistance Receipt Among Overdose Fatalities in British Columbia

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by Grant Schellenberg, Yan Zhang and Christoph Schimmele
Social Analysis and Modelling Division, Statistics Canada

11-626-X No. 090
Release date: April 10, 2019

This article in the Economics Insights series documents the employment histories and income sources of people who died of an illicit drug overdose in British Columbia from January 1, 2007, to December 31, 2016. The data are from the British Columbia (BC) Coroners Service and from administrative data files. The majority of people who died from an illicit drug overdose in British Columbia appear to have occupied a position of economic vulnerability for a considerable portion of their lives, characterized by low and decreasing employment and increasing reliance on social assistance. There are also marked differences in employment, earnings, and social assistance receipt between women and men, younger and older age groups, and between subsets of male overdose fatalities who had sustained, marginal, or near-absent levels of labour force attachment.

Introduction

From 2011 to 2016, there were over 2,350 fatalities from illicit drug overdosesNote  in British Columbia (Statistics Canada 2018). The British Columbia (BC) Coroners Service (2018) reported that one-fifth of overdose decedents from 2016 to 2017 were people who occasionally used illicit drugs as opposed to people who regularly used drugs. In other jurisdictions, overdoses have been disproportionately concentrated among disadvantaged groups, but have also occurred across the socioeconomic spectrum (Cairncross et al. 2018; Ho 2017). This heterogeneity suggests that different points of intervention may be needed to effectively address the increase in fatal overdoses.

In the research literature, the sociodemographic characteristics and risk behaviours of people who use illicit drugs have received the most attention, and previous studies have also focused largely on marginalized groups (Fischer et al. 2005; Kerr et al. 2007; King et al. 2014). Information on the economic characteristics of people at risk of overdose remains sparser, particularly in terms of heterogeneity within this population and longitudinal profiles. This study begins to address these gaps by documenting the employment histories and income sources of people who died from an illicit drug overdose in British Columbia from January 1, 2007, to December 31, 2016. Differences in employment, earnings, and social assistance receipt are documented among men and women and across age groups, with emphasis placed on the strength of labour force attachment by different groups and over time.

A primary objective is to provide information that may be relevant to intervention strategies. “Points of contact” between people who use drugs and formal organizations, such as businesses and public sector agencies, are one consideration in such strategies. The results below offer some perspective on the prevalence of such contacts.

Data are from the BC Coroners Service and from administrative data files containing information on employment earnings and social assistance benefits. The linkage of these files was conducted through Statistics Canada’s Social Data Linkage Environment (SDLE), which is a secure linkage environment for the creation of linked data files (Greenland 2018). The linkage was approved by senior management at Statistics Canada and complies with the agency’s Directive on Microdata Linkage. Further information on the data sources and methods is provided in the “Data and methods” section, which can be found after the “Conclusions and implications” section.

Men and women

The study sample consists of 3,128 deceased individuals. Of these 3,128 decedents, 2,399 (77%) were men and 729 (23%) were women. Attachment to paid employment, as measured by receipt of T4 earnings (earnings obtained from the T4 Statement of Remuneration [T4] file), was lower among the male and female decedents in this study compared to the average population. In the one year prior to the year of death (noted as T-1), just under one-half (48%) of men and over one-quarter (28%) of women had employment. In comparison, among British Columbian taxfilers aged 15 to 64 in 2015, 77% of males and 73% of females had employment, according to the same measure.

Among decedents, attachment to paid employment was stronger among men than women. In each year from T-5 to T-1, about one-half (48% to 51%) of men had some level of employment while this was the case for less than one-third (28% to 32%) of women. Among those employed, average annual earnings were about two times higher among men ($30,000) than women ($15,000).

From a longitudinal perspective, results over the five years prior to death show that 28% of men had employment in all five years (Table 1-1). With average annual earnings of $42,200, this group appears to have had substantial and sustained attachment to paid employment while the situation was quite different for all other decedents. Overall, 14% of women were employed in all five years, with average annual earnings of $22,000. At the other end of the distribution, one-half (51%) of women did not have employment in any of the previous five years. A further 19% of women had employment in just one or two years, with annual earnings averaging less than $5,000.

Participation in formal employment was weak or absent for some 70% of female decedents. This was the case for one-half of men: 29% had no employment and 21% had employment in one or two years out of the five-year period. Given that most female decedents did not have paid employment, workplace-based interventions would likely not have reached many of them. Among those with employment, the largest share (25%) worked in accommodation and food services. This accounted for 13% of all female decedents, reflecting their low rates of employment.

In terms of social assistance, one-half of women received social assistance income in every year over the five years preceding death, and another 8% received it in four of the five years.  About one-quarter of men received social assistance in every year over the five years preceding their death, and just under 7% received it in four of the five years.


Table 1-1
Selected income characteristics of decedents over the five years prior to death — T4 earnings
Table summary
This table displays the results of Selected income characteristics of decedents over the five years prior to death — T4 earnings. The information is grouped by Number of years with T4 earnings (appearing as row headers), Men and Women, calculated using percent and 2016 constant dollars units of measure (appearing as column headers).
Number of years with T4 earnings Men Women
Percentage Mean annual T4 earnings Mean cumulative T4 earnings Percentage Mean annual T4 earnings Mean cumulative T4 earnings
percent 2016 constant dollars percent 2016 constant dollars
0 28.9 Note ...: not applicable Note ...: not applicable 51.0 Note ...: not applicable Note ...: not applicable
1 10.5 7,300 7,300 11.5 4,800 4,800
2 10.3 11,300 22,700 7.1 4,800 9,500
3 10.0 16,200 48,500 8.4 8,800 26,400
4 12.4 19,400 77,400 8.2 11,100 44,500
5 27.9 42,200 211,200 13.7 22,000 109,800

Table 1-2
Selected income characteristics of decedents over the five years prior to death — Social assistance (SA) income
Table summary
This table displays the results of Selected income characteristics of decedents over the five years prior to death — Social assistance (SA) income. The information is grouped by Number of years with SA income (appearing as row headers), Men and Women, calculated using percent and 2016 constant dollars units of measure (appearing as column headers).
Number of years with SA income Men Women
Percentage Mean annual SA income Mean cumulative SA income Percentage Mean annual SA income Mean cumulative SA income
percent 2016 constant dollars percent 2016 constant dollars
0 44.8 Note ...: not applicable Note ...: not applicable 22.5 Note ...: not applicable Note ...: not applicable
1 8.4 3,100 3,100 4.1 4,000 4,000
2 6.4 4,300 8,700 8.5 5,500 10,900
3 8.0 5,300 15,900 7.3 6,000 18,000
4 6.7 6,100 24,500 8.0 7,100 28,600
5 25.7 9,100 45,400 49.7 10,000 50,000

Table 1-3
Selected income characteristics of decedents over the five years prior to death — T4 earnings and/or social assistance (SA) income
Table summary
This table displays the results of Selected income characteristics of decedents over the five years prior to death — T4 earnings and/or social assistance (SA) income. The information is grouped by Number of years with T4 earnings and/or SA income (appearing as row headers), Men and Women, calculated using percent and 2016 constant dollars units of measure (appearing as column headers).
Number of years with T4 earnings and/or SA income Men Women
Percentage Mean annual income Mean cumulative income Percentage Mean annual income Mean cumulative income
percent 2016 constant dollars percent 2016 constant dollars
0 7.4 Note ...: not applicable Note ...: not applicable 5.3 Note ...: not applicable Note ...: not applicable
1 5.3 8,100 8,100 3.2 6,200 6,200
2 6.3 13,400 26,700 5.2 5,900 11,800
3 8.1 13,700 41,100 6.9 8,100 24,200
4 13.0 17,600 70,200 9.9 8,900 35,500
5 59.9 25,800 129,000 69.5 13,100 65,700

The results are consistent with those of Richardson et al. (2010) and Amundsen (2015), who reported low levels of employment and high levels of social assistance reliance among people who use drugs as well as people who died from an overdose. The results are also consistent with the point that women who regularly use illicit drugs tend to encounter greater barriers to formal employment than their male counterparts (Richardson et al. 2010; DeBeck et al. 2007). Finally, the socioeconomic diversity observed by Amundsen (2015) and Ho (2017) is evident, perhaps most notably by the subsets of male decedents who had sustained, marginal, or low levels of labour force attachment.

Age groups

The age at which decedents died is another dimension across which labour force ties and social income receipt varied. Chart 1 shows the shares of male and female decedents in each age group who received T4 earnings or social assistance benefits in the year prior to death. The steady decline in employment across successive age groups is clear, as is the steady increase in social assistance receipt.

Chart 1 Percent of decedents receiving T4 earnings or social assistance benefits in year T-1, by sex and age at death

Data table for Chart 1 
Data table for chart 1
Table summary
This table displays the results of Data table for chart 1 T4 earnings, Social assistance, Men and Women, calculated using percent units of measure (appearing as column headers).
T4 earnings Social assistance
Men Women Men Women
percent
15 to 24 years 62.2 45.8 24 36
25 to 34 years 56.8 40.1 36 69
35 to 44 years 48.5 26.3 47 79
45 to 54 years 41.9 14.9 56 83
55 years and older 27.3 Note ...: not applicable 56 80

Further analysis is needed to determine what accounts for the decline in employment across age groups; however, the results are consistent with the argument that regular substance use gradually erodes the capacity for work. For example, Bachi et al. (2017) provide evidence that biological aging is accelerated in people who regularly use drugs, increasing their susceptibility to chronic illness and disabilities, while other studies observe that poor health is a principal barrier to obtaining employment for such people (Bauld et al. 2010; Sutton et al. 2004). In the present study sample, only male decedents under 35 years of age had employment rates above 50% in the year prior to death.

The right-hand portion of Chart 1 shows a noticeably higher rate of social assistance receipt among women and the 35-and-older age groups. About 80% of women aged 35 and older and 70% of those aged 25 to 34 received such benefits in the year prior to death. Over one-half of men aged 35 and older did so as well. This shows the prevalence of contact between these groups and provincial and other benefit-granting agencies, insofar as “contact” is meaningfully captured by receipt of income support benefits. Benefit-granting agencies were not as prevalent a point of contact for younger male decedents (those who died before age 35) as about one-third of them received social assistance income in T-1. In contrast, employers were a more prevalent point of contact. Of the young male decedents with employment, the largest share (29%) worked in the construction sector. This accounted for 24% of all young male decedents regardless of employment status.Note Note 

Among male decedents who died at age 35 and older, less than half had employment in T-1. Again, among those who did, the largest share (24%) worked in the construction sector (Table 2). This accounted for 17% of all older male decedents regardless of employment status. By comparison, 13% of British Columbian males aged 15 to 54 received T4 earnings from construction. The construction industry in British Columbia employs over 110,000 male employeesNote  across many trades, employers and job sites.  


Table 2
Percent of decedents by main industry of employment in the five years prior to death
Table summary
This table displays the results of Percent of decedents by main industry of employment in the five years prior to death Male overdose decedents who died before age 35, Male overdose decedents who died at age 35 to 54, Male British Columbia residents aged 15 to 54 with T4 earnings (>$500) in 2015, Percentage of those with T4 employment and Percentage of all decedents, calculated using percent units of measure (appearing as column headers).
Male overdose decedents who died before age 35 Male overdose decedents who died at age 35 to 54 Male British Columbia residents aged 15 to 54 with T4 earnings (>$500) in 2015
Percentage of those with T4 employment Percentage of all decedents Percentage of those with T4 employment Percentage of all decedents
percent
Industry
Construction 28.8 24.4 24.3 16.8 13.2
Administrative and support, waste management and remediation services 8.4 7.1 13.7 9.5 5.2
Manufacturing 10.2 8.6 11.6 8.0 9.5
Accommodation and food services 11.5 9.8 6.3 4.4 8.3
Retail trade 9.5 8.1 5.6 3.9 11.6
Transportation and warehousing 4.5 3.8 8.4 5.8 6.4
Other industries 27.0 22.9 30.0 20.7 45.8
Total employed in the five years prior to death 100.0 84.7 100.0 68.9 100.0
Not employed in the five years prior to death Note ...: not applicable 15.3 Note ...: not applicable 31.1 Note ...: not applicable
Total Note ...: not applicable 100.0 Note ...: not applicable 100.0 Note ...: not applicable

Shorter- and longer-term perspectives

A further issue is whether the economic characteristics of overdose decedents changed markedly in the years prior to death. For instance, were precipitous declines in employment or earnings evident that might suggest withdrawal from paid employment and increasing economic vulnerability over this period? 

Among decedents aged 25 and older, the incidence of employment declined by 6 to 7 percentage points from T-5 to T-1 among men within age groups, and by 4 to 7 percentage points among women within age groups (Chart 2). Notably, among those with employment, average annual earnings did not exhibit a clear decline from T-5 to T-1. This suggests that labour force withdrawal occurred through a transition from employment to non-employment rather than through reductions in annual hours worked.Note  It bears noting that, overall, the magnitude of employment declines were not so large (nor consistent in the case of earnings) as to suggest widespread withdrawal from paid employment.

Nonetheless, social assistance receipt increased markedly over the five-year period, particularly among people who died at younger ages (Chart 3). Among decedents aged 15 to 24, social assistance receipt increased five-fold among men (from 5% to 24%) and three-fold among women (from 12% to 36%). Among decedents aged 25 to 34, the incidence of receipt increased by 11 percentage points among men and 18 percentage points among women. Increases were smaller among people who died at older ages, in part because social assistance receipt was generally prevalent by that point.

Chart 2 Percent of decedents receiving T4 earnings, by sex, age at death, and year relative to death

Data table for Chart 2 
Data table for chart 2
Table summary
This table displays the results of Data table for chart 2. The information is grouped by Year relative to death (appearing as row headers), Men, Women, 15 to 24, 25 to 34, 35 to 44, 45 to 54, 55 and older and 45 and older, calculated using percent units of measure (appearing as column headers).
Year relative to death Men Women
15 to 24 25 to 34 35 to 44 45 to 54 55 and older 15 to 24 25 to 34 35 to 44 45 and older
percent
Year T-5 47.3 62.6 54.4 48.9 33.5 42.1 47.3 32.0 18.8
Year T-4 59.9 60.6 51.6 45.9 34.7 49.5 44.9 28.9 17.6
Year T-3 64.1 58.3 50.5 44.4 31.8 51.4 43.1 30.9 17.2
Year T-2 64.9 60.5 49.5 46.1 28.2 51.4 38.3 25.8 14.9
Year T-1 62.2 56.8 48.5 41.9 27.3 45.8 40.1 26.3 14.9

Chart 3 Percent of decedents receiving social assistance income, by sex, age at death, and year relative to death

Data table for Chart 3 
Data table for chart 3
Table summary
This table displays the results of Data table for chart 3. The information is grouped by Year relative to death (appearing as row headers), Men, Women, 15 to 24, 25 to 34, 35 to 44 and 45 to 54, calculated using percent units of measure (appearing as column headers).
Year relative to death Men Women
15 to 24 25 to 34 35 to 44 45 to 54 15 to 24 25 to 34 35 to 44 45 to 54
percent
Year T-5 5 25 39 49 12 51 64 77
Year T-4 9 27 40 48 17 53 69 81
Year T-3 12 31 42 53 22 59 70 83
Year T-2 17 31 45 54 29 62 75 82
Year T-1 24 36 47 56 36 69 79 83

Evidence over the longer term provides a more comprehensive perspective on the workforce attrition and economic marginalization of overdose decedents. To document this, male decedents were grouped by age at death into five-year categories (e.g., aged 30 to 34, 35 to 39), and the average annual unconditional T4 earnings of each age group was calculated for each of the 18 years preceding death (i.e., T-18 to T-1).Note  Average unconditional earnings—calculated as average annual T4 earnings of all decedents regardless of whether they had employment—provide a useful summary measure reflecting both the incidence of employment and the average earnings received. Given the focus on labour force attachment, the analysis is limited to male decedents. Comparison groups of British Columbian men who were the same age as the decedents were drawn from the general population of taxfilers.

As shown in Chart 4, the difference in average unconditional earnings among male decedents aged 30 to 34 and the comparison group was less than $1,000 at age 20 to 24, but widened to over $27,000 by age 29 to 33. In slightly different terms, the average unconditional earnings of male decedents declined from 95% to 38% of those of the comparison group over the observation period. The pattern was much the same among male decedents aged 40 to 44 (Chart 5), with the difference in unconditional earnings widening from just over $4,000 in their early twenties to over $36,000 by their late thirties and early forties. In percentage terms, the average unconditional earnings of these male decedents declined from 77% to 34% of those of the comparison group. 

Chart 4 Average annual unconditional T4 earnings among male decedents aged 30 to 34 and a comparison group of male taxfilers

Data table for Chart 4 
Data table for chart 4
Table summary
This table displays the results of Data table for chart 4. The information is grouped by Age groups (appearing as row headers), Comparison group and Decedents, calculated using average annual unconditional earnings units of measure (appearing as column headers).
Age groups Comparison group Decedents
average annual unconditional earnings
20 to 24 15,400 14,600
21 to 25 18,200 16,600
22 to 26 21,200 17,200
23 to 27 24,100 16,700
24 to 28 27,000 17,100
25 to 29 30,100 18,100
26 to 30 33,300 18,400
27 to 31 36,700 18,200
28 to 32 40,200 17,700
29 to 33 43,600 16,400

Chart 5 Average annual unconditional T4 earnings among male decedents aged 40 to 44 and a comparison group of male taxfilers

Data table for Chart 5 
Data table for chart 5
Table summary
This table displays the results of Data table for chart 5. The information is grouped by Age groups (appearing as row headers), Comparison group and Decedents, calculated using average annual unconditional earnings units of measure (appearing as column headers).
Age groups Comparison group Decedents
average annual unconditional earnings
22 to 26 18,600 14,300
23 to 27 20,600 14,400
24 to 28 22,700 14,500
25 to 29 24,900 17,100
26 to 30 27,100 17,600
27 to 31 29,800 17,400
28 to 32 31,100 18,400
29 to 33 33,900 18,800
30 to 34 36,100 19,500
31 to 35 37,700 20,900
32 to 36 40,100 21,000
33 to 37 42,200 19,700
34 to 38 45,500 18,400
35 to 39 46,900 18,800
36 to 40 48,300 21,600
37 to 41 50,600 18,900
38 to 42 52,700 18,400
39 to 43 54,600 18,500

Conclusions and implications

The majority of decedents in this study appear to have occupied a position of economic vulnerability for a considerable portion of their lives, characterized by no or little formal employment and increasing reliance on social assistance over time. Observed incomes were generally modest or low.

However, within the context of economic marginalization, heterogeneity is evident. Considerable differences in the labour force attachment and social assistance receipt are observed between men and women, and across age groups. In addition, while most decedents were economically vulnerable, a subset of the male population had sustained employment and substantial earnings over the five years prior to death. This latter group appears to be distinct from all other overdose decedents.

This heterogeneity may be important with respect to intervention strategies. Employers and workplaces, particularly those in the construction sector, are points of intervention that warrant consideration for reaching younger men. The study observed that one in four male overdose decedents who died before age 35 worked in this sector in the years prior to their deaths. Given low rates of employment among female overdose decedents and for most male overdose decedents in older age groups, interventions geared toward employers and workplaces may offer less promise. Contact between these groups and social service agencies were more prevalent.

The inclusion of additional administrative data files in subsequent research could be helpful in providing a more complete picture of income sources and other potential points of intervention. For example, overdose decedents may be over-represented among recipients of Canada Pension Plan Disability benefits given their age (i.e., non-seniors), low rate of employment, and possible health problems. Similarly, more detailed information on social assistance benefits is available from provincial files than from T5007 Statements of Benefits, such as month of last benefit receipt relative to month of death. This information could be helpful in piecing together key transitions among at-risk populations. Beyond income alone, a more comprehensive assessment of points of contact could be provided by looking at interactions with social service agencies, the criminal justice system, and health care providers.

Data and methods

Five administrative data files were linked together for this analysis. First, the universe of people who died of a confirmed illicit drug overdose in British Columbia from January 1, 2007, to December 31, 2016, was drawn from the British Columbia (BC) Coroners Service Database. Second, information on the paid employment of decedents was drawn from the T4 Statement of Remuneration (T4) file. Employers are required to complete and submit T4 slips for employees paid over $500 in a tax year or for whom Canada Pension Plan or Quebec Pension Plan contributions, employment insurance benefits, or income taxes were deducted. Third, information on social assistance benefits received was drawn from the T5007 Statements of Benefits (T5007) file. Provincial and other benefit-granting agencies are required to submit T5007 slips for payments over $500 made to beneficiaries in a tax year. Social assistance refers to payments to people for basic needs (food, clothing, and shelter) and is based on a means, needs, or income test. Fourth, information on industry of employment of T4 recipients was drawn from the Longitudinal Employment Analysis Program (LEAP) maintained by Statistics Canada. Finally, the T1 Family File was used to produce earnings trajectories for a comparison group of taxfilers in the general population of British Columbia.

Both the T4 and T5007 files are submitted directly to the Canada Revenue Agency (CRA) by the payers. No action on the part of employees or beneficiaries is required to be included in these files. Hence, these sources provide information that is both comprehensive and robust. Information on other government transfers, such as employment insurance and Canada Pension Plan Disability benefits, and other sources of market income, such as self-employment, are not available in the linked analytical file.

The study sample consists of 3,128 people, 2,399 males and 729 females. Age refers to a person’s age group at death. The year of death is identified as year T, while years prior to the year of death are identified as T-1, T-2, and so on. Incidence of employment is defined as the share of T4 earners of over $500 (from all jobs) among all decedents in a given year. Total observed income is defined as the sum of T4 earnings and social assistance income. All earnings and income estimates are calculated on an annual basis and expressed in 2016 constant dollars.

References

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Bauld, L., G. Hay, J. McKell, and C. Carroll. 2010. Problem Drug Users’ Experiences of Employment and the Benefit System. Research Report No. 640. Norwich, United Kingdom: Department for Work and Pensions.

British Columbia (BC) Coroners Service. 2018. Illicit Drug Overdose Deaths in BC: Findings of Coroners’ Investigations. Victoria, BC: Ministry of Public Safety and Solicitor General.

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Kerr, T., N. Fairbairn, M. Tyndall, D. Marsh, K. Li, J. Montaner, and E. Wood. 2007. “Predictors of Non-Fatal Overdose Among a Cohort of Polysubstance-Using Injection Drug Users.” Drug and Alcohol Dependence 87 (1): 39–45.

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