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Income disparities in health-adjusted life expectancy for Canadian adults, 1991 to 2001
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by Cameron N. McIntosh, Philippe Finès, Russell Wilkins and Michael C. Wolfson
Abstract
Keywords
Findings
Authors
What is already known on this subject?
What does this study add?
Abstract
Background
Health-adjusted life expectancy is a summary measure of population health that combines mortality and morbidity data into a single index. This article profiles differences in health-adjusted life expectancy across income categories for a representative sample of the Canadian population.
Data and methods
Mortality data were obtained from the 1991-2001 Canadian census mortality follow-up study, which linked a 15% sample of the 1991 adult non-institutional population with 11 years of death records from the Canadian Mortality Data Base. Information on morbidity was obtained from the Health Utilities Index Mark 3 instrument on the 2000/2001 Canadian Community Health Survey. The Sullivan method was used to compute health-adjusted life expectancy for national deciles of population ranked by income.
Results
For both sexes, and with few exceptions, a nearly linear gradient across income deciles emerged for health-adjusted life expectancy at age 25. Compared with people in higher-income deciles, those in lower-income deciles had fewer years of health-adjusted life expectancy. These disparities were substantially larger than those revealed by life expectancy alone.
Interpretation
These findings highlight the generally worse health-related quality of life of lower-income groups. The results demonstrate that assessments of socio-economic disparities in health should include the effects of both mortality and morbidity.
Keywords
health inequalities, Health Utilities Index, life expectancy, socio-economic, Sullivan method
Findings
The dramatic increase in life expectancy in Canada and other economically developed nations during the last century stands as testimony to the success of improvements in public health and advances in medical care. But despite these gains in longevity, inequalities in health outcomes across different subpopulations are still pervasive in Canada and other industrialized countries. [Full text]
Authors
Cameron N. McIntosh (1-613-949-4135; Cameron.McIntosh@ps.sp.gc.ca) is with Public Safety Canada. Philippe Finès (1-613-951-3896; Philippe.Fines@statcan.gc.ca) and Russell Wilkins (1-613-951-5305; Russell.Wilkins@statcan.gc.ca) are with the Health Analysis Division at Statistics Canada. Michael C. Wolfson (1-613-951-8216; Michael.Wolfson@statcan.gc.ca) is with Statistics Canada, Ottawa, Ontario, K1A 0T6.
What is already known on this subject?
- Findings from Canada and other countries have consistently demonstrated that accounting for morbidity as well as mortality reveals even greater socio-economic disparities in health outcomes, because of the generally worse morbidity experience of disadvantaged persons.
What does this study add?
- This is the first study to provide nationally representative estimates of socio-economic inequalities in health-adjusted life expectancy for the adult household population of Canada, using individual-level measures of socio-economic status, mortality and morbidity.
- For both sexes, disparities in health-adjusted life expectancy between the highest and lowest income groups were substantially greater than those for life expectancy alone.
