Abstract

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Background

The routine measurement of population health status indicators like mortality is important to assess progress in the reduction of inequalities. Previous studies of mortality inequalities have relied on area-based measures of socioeconomic indicators. A new series of census-mortality linked datasets has been created in Canada to quantify mortality inequalities based on individual-level data and examine whether these inequalities have changed over time.

Methods

This study used the 1991, 1996, 2001, 2006, and 2011 Canadian Census Health and Environment Cohorts (CanCHECs) with five years of mortality follow-up. It estimated age-standardized mortality rates by sex according to income quintile and highest level of educational attainment categories for the household population aged 25 or older. Absolute and relative measures of mortality inequality were also estimated.

Results

Men had a greater reduction in mortality rates over time compared with women, regardless of income or education level. Absolute income-related mortality inequality decreased for men but increased for women over time, while relative income-related inequality increased for both sexes. Education-related mortality inequality for women followed the same pattern as income, though the absolute mortality difference for men remained roughly unchanged over the period.

Interpretation

Mortality inequalities by income and education persist in Canada, and have increased for women. Further research to determine the mechanisms underlying these trends could help address the complex challenge of reducing health inequalities in Canada.

Keywords

socioeconomic factors, mortality, health equity, population health, census

DOI: https://www.doi.org/10.25318/82-003-x201901200002-eng

Findings

Health inequalities can be defined as avoidable differences in health status between population groups. These differences have been attributed to personal, social, economic and environmental factors. For example, income has been tied to health outcomes in that people with low income may have less access to health services and higher-quality material resources (such as shelter and food), and the knowledge and skills obtained through formal education can influence the understanding of health messaging and the ability to effectively access health services. The routine measurement of population health status indicators like mortality is important to assess progress in the reduction of inequalities and is a priority in Canada. Though mortality rates overall have been decreasing over time, inequalities remain. In the past, people in higher socioeconomic groups have experienced lower mortality rates than those with less income or lower educational attainment. Despite increasing attention and actions taken, regional studies suggest that mortality inequalities across socioeconomic groups may be increasing in Canada, especially for women. [Full article]

Authors

Emma Marshall-Catlin (emarshall-catlin@cihi.ca) is with the Canadian Institute for Health Information. At the time of the writing of this article she was with the Health Analysis Division at Statistics Canada, Ottawa, Ontario. Tracey Bushnik and Michael Tjepkema are also with the Health Analysis Division.

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