Abstract
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Background
Keywords
Findings
Authors
What is already known on this subject?
What does this study add?
Background
People with lower incomes tend to have less favourable health outcomes than do people with higher incomes. Because death registrations in Canada do not contain information about the income of the deceased, vital statistics cannot be used to examine mortality by income at the individual level. However, through record linkage, information on the individual or family income of people followed for mortality can be obtained. Recently, a large, population-based sample of Canadian adults was linked to almost 16 years of mortality data.
Methods
This study examines cause-specific mortality rates by income adequacy among Canadian adults. It is based on data from the 1991 to 2006 Canadian census mortality and cancer follow-up study, which followed 2.7 million people aged 25 or older at baseline, 426,979 of whom died during the 16-year period. Age-standardized mortality rates (ASMRs), rate ratios, rate differences and excess mortality were calculated by income adequacy quintile for various causes of death.
Results
For most causes examined, ASMRs were clearly graded by income: highest among people in the in the lowest income quintile, and lowest among people in the highest income quintile. Inter-quintile rate ratios (quintile 1/quintile 5) were greater than 2.00 for HIV/AIDS, diabetes mellitus, suicide, cancer of the cervix, and causes of death closely associated with smoking and alcohol.
Interpretation
These individually based results provide cause-specific information by income adequacy quintile that was not previously available for Canada.
Keywords
Age-standardized mortality rates, rate ratios, rate differences, socio-economic inequalities
Findings
Income is a well-established health determinant—people with lower incomes tend to experience less favourable health outcomes, including poorer self-rated health, higher prevalence of disease, and decreased life expectancy, than do people with higher incomes. Income influences health most directly through access to material resources such as better quality food and shelter. [Full Text]
Authors
Michael Tjepkema (1-613-951-3896; michael.tjepkema@statcan.gc.ca) is with the Health Analysis Division at Statistics Canada, Ottawa, Ontario K1A 0T6. Russell Wilkins is with the Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario. Andrea Long is with the Public Health Agency of Canada, Ottawa, Ontario.
What is already known on this subject?
- People with lower incomes tend to have less favourable health outcomes than do people with higher incomes.
- Because death registrations in Canada do not contain information about the income of the deceased, vital statistics cannot be used to examine mortality rates by income at the individual level.
- Through record linkage, information on the income of people followed for mortality can be obtained.
- Recently, a large population-based sample of Canadian adults was linked to almost 16 years of mortality data.
What does this study add?
- Data from the 1991 to 2006 Canadian census mortality and cancer follow-up study, which tracked mortality in a 15% sample of the 1991 adult population of Canada, were used to assess cause-specific variations in mortality by income.
- Income gradients in mortality emerged for most causes of death.
- Causes more closely associated with health risk behaviours tended to have particularly steep mortality gradients.
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