Abstract

Background

The avoidable mortality rate is a key indicator of overall health and health care utilization. However, the avoidable mortality rate may differ by the relative remoteness of a community. Avoidable mortality rates specific to remote areas cannot be investigated unless there is a clear geographic classification of remoteness. Therefore, this research uses a newly developed remoteness index to explore the geographic variability of avoidable mortality in Canada.

Data and methods

The remoteness index, Canadian Vital Statistics—Death Database (2011 to 2015), and the 2016 Census of Population are used to understand the geographic variability of preventable and treatable mortality rates in Canada. Descriptive and multivariate data analysis techniques are used to test the hypothesis that remoteness is one of the statistically significant predictors of avoidable mortality rates in Canada.

Results

There is a clear gradient of preventable and treatable mortality rates by relative remoteness. The preventable and treatable mortality rates are significantly higher in more remote areas than in easily accessible areas. The remoteness index is a good predictor of both preventable and treatable causes of mortality for low-Aboriginal census subdivisions but not for high-Aboriginal census subdivisions in Canada.

Interpretation

Both preventable and treatable mortality rates vary significantly by remoteness, despite Canada’s universal health care system. The remoteness of Canadian communities may have affected health care delivery and utilization.

Keywords

Remoteness, preventable mortality, treatable mortality, health status, health outcome, income, education, Aboriginal population

DOI: https://www.doi.org/10.25318/82-003-x201900500001-eng

Findings

Despite the tremendous amount of ongoing research, the mechanism of urban–rural health disparities is not fully understood in Canada. Although rural and remote location in itself may not necessarily lead to poor health, it may influence other socioeconomic, environmental and occupational health determinants. There is noticeable heterogeneity within and between rural communities in Canada in terms of socioeconomic and geographic characteristics. However, in general, people who live in rural communities have limited access to health care services and have worse health outcomes than their urban counterparts. This may lead to disproportionate mortality rates between urban and rural communities. [Full Text]

Authors

Rajendra Subedi (Rajendra.Subedi@canada.ca), T. Lawson Greenberg and Shirin Roshanafshar are with the Health Statistics Division at Statistics Canada, Ottawa, Ontario.

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What is already known on this subject?

  • According to the Canadian Institute for Health Information, approximately 72% of premature deaths in Canada are considered avoidable.
  • Avoidable mortality has been used as an indicator of health policy, health care delivery and health care utilization.
  • In Canada, avoidable mortality rates vary significantly by province and territory, and by neighbourhood income level and sex.

What does this study add?

  • The remoteness index can be used as a new dimension to measure the geographic variability of avoidable mortality in Canada.
  • There is a clear gradient of both preventable and treatable mortality rates by relative remoteness of Canadian communities, with more remote communities having higher rates.
  • The remoteness index is an important determinant of both preventable and treatable mortality rates for low-Aboriginal CSDs in Canada that takes into account education level and household income.

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