Abstract

Background

Life expectancy (LE) and health expectancy have increased throughout much of the world. However, these gains have not been shared equally across all population groups. Socioeconomic disparities exist, though varied methodologies and data sources have made it difficult to ascertain changes over time in Canada.

Methods

The 1996 and 2011 Canadian Census Health and Environment Cohorts, with a five-year mortality follow-up, were used to estimate the LE of the household population at ages 25 and 65, according to individual-level education and income. Health status was measured by the Health Utilities Index Mark 3 instrument in two national population health surveys and was used to adjust LE to estimate health-adjusted life expectancy (HALE). Disparities in LE and HALE, and differences between cohorts, were examined.

Results

LE, HALE and the ratio of HALE to LE were greater at higher levels of education or income. A stepwise gradient was also observed by level of education within and across income quintiles, with people in the lowest combined education and income categories at the greatest disadvantage. Disparities were wider in the 2011 cohort compared with the 1996 cohort, but not necessarily to the same extent for both sexes or at different ages.

Interpretation

In Canada, education-related and income-related disparities in life and health expectancy persist and may be wider than they were in the past. This underscores the importance of ongoing data development for routine monitoring of trends in mortality and morbidity, which can, in turn, inform policy development and planning to advance health equity.

Keywords

health equity, health disparities, life expectancy, health expectancy, Health Utilities Index, income, education

DOI: https://www.doi.org/10.25318/82-003-x202000100001-eng

Findings

Life expectancy (LE) and health expectancy have increased throughout much of the world, including Canada. However, these gains in years lived and years lived in good health are not distributed equally across all population groups. Disparities exist, particularly according to socioeconomic position. Understanding the magnitude, distribution and shift over time in these disparities is increasingly relevant for policy development and planning to advance health equity. [Full article]

Authors

Tracey Bushnik (tracey.bushnik@canada.ca) and Michael Tjepkema are with the Health Analysis Division and Laurent Martel is with the Centre for Demography at Statistics Canada, Ottawa, Ontario.

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