Health at a Glance

Disparities in life expectancy at birth

by Lawson Greenberg and Claude Normandin

 

Highlights

  • While Canada's life expectancy ranks among the top in the world, regional figures reveal important differences within the country.
  • Regions facing the lowest life expectancy also possess some of the highest rates of smoking, obesity, and heavy drinking. These regions have high long-term unemployment rates, lower levels of education, small immigrant populations, relatively large Aboriginal populations, and are situated in rural/remote locations.
  • Higher neighbourhood income is associated with longer life expectancy.
  • Women in Canada tend to live longer than men, on average. This gap has been present for nearly a century, and it varies across the country and by income group.

Introduction
Canada is among the top countries in the world
Canadian life expectancy has improved dramatically over the past century
A closer look reveals differences
Lower income is associated with shorter life expectancy
Summary
References
Appendix 1

Introduction

The ultimate health outcome is how long one lives: thus, life expectancy at birth—the number of years a person is expected to live—is widely used to explore the general health of a population.1 Life expectancy is also useful for comparing various groups of people, between or even within nations. Identifying gaps in life expectancy between different groups helps draw attention to particularly vulnerable populations. However, life expectancy measures the length rather than the quality of life, so it does not necessarily represent the number of years spent in good health.2

This article begins with a comparison of Canadian life expectancy to that of other countries. The rest of the article looks within Canada to reveal changes in life expectancy over time, differences between regions and variations across income groups. The regional differences are presented alongside the characteristics of these regions, including population density and remoteness, as well as rates of smoking, drinking and obesity. Gender differences are observed throughout the article.

Canada among the top 10 countries in the world

For the past 50 years, life expectancy at birth in Canada has ranked in the top 10 among the 34 countries now in the Organisation for Economic Co-operation and Development (OECD). In 2007, the most recent period for which data are available for all OECD countries, Canada ranked ninth, with a life expectancy at birth of 80.7 years for both sexes combined (Chart 1). This was 1.9 years lower than the first-ranked country, Japan. Canadian men were in eighth place, 1.2 years below top-ranked Switzerland, and Canadian women were tied for ninth with Sweden, 3.0 years below Japan.3

The gap in life expectancy between males and females differs by country. In Canada, life expectancy at birth is 4.7 years longer for women than men. Among the top 10 OECD countries, the gap in life expectancy is largest in France (7.0 years) and smallest in Iceland (3.5 years).3

Chart 1 Frequency of religious attendence, 1985 to 2005.Chart 1
Life expectancy at birth, top 10 OECD countries

Canadian life expectancy has improved dramatically over the past century

Life expectancy in Canada has improved considerably since early in the 20th century. Women's life expectancy at birth has increased from 60.6 years in 1920–19224 to 83.0 years in 2005–2007, and men's from 58.8 to 78.3 years in the same period—increases of 22.4 years for women and 19.5 for men (Chart 2).

The lower life expectancy of earlier decades was, in part, a reflection of high levels of infant mortality—about 1 in 10 children died within the first year of life in 1921. Because of high levels of infant mortality, life expectancy at age 1 was actually higher than life expectancy at birth until the 1980-to-1982 period, when infant mortality lowered enough to reduce this trend.4

Chart 2 Life expectancy at birth and at age 1,  by sex, Canada, 1920/1922 to 2005/2007.Chart 2
Life expectancy at birth and at age 1, by sex, Canada, 1920–1922 to 2005–2007

The gap in life expectancy at birth between the sexes has changed over time. In the 1920–1922 period, the gap was 1.8 years. It widened steadily to 7.4 years in 1975–1977, then narrowed to 4.7 years by 2005–2007. The gap between the sexes is partly related to differences in lifestyle, such as men's greater propensity to risk-taking behaviours that could result in injury or death.5 The expansion of the gap in the early and mid-20th century was, in part, owing to a reduction in the likelihood of maternal death during childbirth; the narrowing later on was related somewhat to improvements in cardiac health (men are generally more affected by heart problems than women).6

A closer look reveals differences

Life expectancy at birth varies across Canada. Among the provinces in 2005–2007, British Columbia had the longest life expectancy, 81.2 years, and Newfoundland and Labrador the lowest, 78.3 years. The gap between the sexes ranged from 4.3 years in Ontario to 5.1 years for Prince Edward Island, Nova Scotia, New Brunswick and Saskatchewan. In the territories, life expectancy was lower, 75.8 years, and the gap between the sexes was wider, 6.0 years.

Chart 3 Life Expectancy at Birth, Provinces and  Territories, 2005/2007.Chart 3
Life Expectancy at Birth, Provinces and Territories, 2005-2007

Life expectancy at the health region level revealed large disparities, from a low of 71.3 years to a high of 84.6 years: see Appendix 1 for a list of Health Regions and their associated life expectancy. Health regions with the lowest life expectancies are comparable to countries such as Iran, 71.3 years; Lebanon, 72.0 years; Poland, 75.6 years; and Albania, 76.5 years;7 and are similar to the overall Canadian figures from the 1960s.

The gap in life expectancy between males and females varies widely across health regions, from 3.2 years to 7.5 years. The gap was generally smaller among regions with higher life expectancy and wider among regions with lower life expectancy.

Map 1 Life Expectancy at Birth by Health Region, 2005/2007.Map 1
Life Expectancy at Birth by Health Region, 2005-2007

Although 23 of Canada's health regions have life expectancy values significantly higher than the Canadian average (the green areas in Map 1), ranging from 81.0 to 84.6 years, they comprise 51% of the population. In contrast, the 79 regions that have life expectancy values significantly lower than the Canadian average (the orange areas in Map 1) account for just 37% of the population, but the range of life expectancy across these regions was wide, 9.1 years.

Health regions with life expectancies lower than the Canadian average share similar characteristics. They tend to have higher levels of long-term unemployment, lower proportions of high school and university graduates, smaller immigrant populations, larger Aboriginal populations and rural/remote locations.8 The association between these characteristics and low life expectancy has been documented in prior research.9, 10, 11

Health regions with the lowest life expectancies also tend to have some of the highest rates of smoking, obesity and heavy drinking (Chart 4), all associated with poor health. Smoking is a risk factor for lung cancer, heart disease and stroke, among other conditions.12 Obesity has been linked to various chronic conditions, such as Type 2 diabetes, cardiovascular disease and hypertension.13 Heavy drinking—consuming at least five alcoholic drinks on one occasion at least once a month—has been associated with serious health problems, such as cirrhosis, heart disease and depression, as well as social consequences, such as traffic accidents, lower productivity and violence.14

Chart 4 Life Expectancy at  Birth, by sex, Income Quintiles, 2005/2007.Chart 4
Life Expectancy at Birth by Rates of Smoking, Obesity, and Heavy Drinking, Health Regions.

Infant mortality and deaths from causes such as suicide and unintentional injuries, which rank high in younger populations,15 are more common in regions with lower life expectancy. Other causes of death, such as respiratory diseases and lung cancer, are also among the highest in the country in these regions.

Lower income is associated with shorter life expectancy

Previous studies have established that poorer health outcomes, such as high levels of illness and mortality, are associated with low income.16, 17 If the Canadian population is divided into five equal groups (quintiles) according to their neighbourhood income and life expectancy is calculated for each group, the relationship between life expectancy and income can be examined (Chart 5).

Chart 5 Life Expectancy at  Birth, by sex, Income Quintiles, 2005/2007.Chart 5
Life Expectancy at Birth, by sex, Neighbourhood Income Quintiles, 2005-2007

Life expectancy in the highest-income neighbourhoods was higher than in the lowest-income neighbourhoods (Chart 5). Although females have a higher life expectancy than males in all income groups, as income increases, the gap between male and female life expectancy diminishes, from 6.1 years in the lowest income group to 3.7 years in the highest. Additionally, income levels seem to show greater effect for men than women: the gap between the lowest and highest income groups is 4.7 years for men, but 2.3 years  for women.

Summary

Life expectancy in Canada has increased substantially over the past century, and Canada ranks consistently among the top countries in the world. Within Canada, however, notable differences can be seen.

Life expectancy tends to be lower in regions where the rates of smoking, heavy drinking and obesity are relatively high. These regions also have higher levels of long-term unemployment, fewer high school and university graduates, a relatively larger Aboriginal population and are generally rural and remote.

Life expectancy is lower for males than it is for females: this gap has been present to varying degrees for nearly a century. This gap between the sexes is apparent across the country, and is most striking in lower-income groups.

References

  1. Tobias, Martin and Jit Cheung. "Monitoring Health inequalities: life expectancy and small area deprivation in New Zealand." Population Health Metrics 2003; 1(2): 1–11.
  2. Gilmour, Heather and Pamela Ramage-Morin. Healthy People, Healthy Places (Statistics Canada Catalogue no. 82-229-XWE). 1997 [cited 2010 December 20].
  3. Organisation for Economic Co-operation and Development (OECD).Life expectancy at birth and at various ages. OECD Health Data 2010; 2010 [cited 2010 December 7].
  4. Nagunar, Dhruva. Longevity and Historical Life Tables 1921-1981 (Abridged): Canada and the Provinces (Statistics Canada Catalogue no. 89-506-XPB). Ottawa 1986; 215.
  5. Phillips, Susan P. "Risky business: explaining the gender gap in longevity." Journal of Men's Health and Gender. 2006; 3(1): 43–46.
  6. Cutler, David M. and Ellen Meara. "Changes in the age distribution of mortality over the 20th century." NBER Working Paper Series. Working Paper 8556. Cambridge, USA 2001; 23.
  7. United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2008 Revision. 2009 [cited 2010 December 7].
  8. Statistics Canada. Table 109-0300. Census indicator profile, Canada, provinces, territories, health regions (2007 boundaries) and peer groups, every 5 years (table). CANSIM (database). 2010 [cited 2010 December 7].
  9. Tjepkema, Michael, Russell Wilkins, Sacha Senécal, Éric Guimond and Christopher Penney."Mortality of Métis and Registered Indian adults in Canada: An 11-year follow-up study."Health Reports (Statistics Canada Catalogue no. 82-003-X). 2010 [cited 2010 December 30]; 20 (4): 31–51.
  10. Wilkins, Russell, Sharanjit Uppal, Phillipe Finès, Sacha Senécal, Éric Guimond and Rene Dion. "Life expectancy in the Inuit-inhabited areas of Canada, 1989 to 2003."Health Reports (Statistics Canada Catalogue no. 82-003-X). 2008 [cited 2010 December 30]; 19(1): 7–19.
  11. Gilmore, Jason and Brenda Wannell. "Life Expectancy."Health Reports (Statistics Canada Catalogue no. 82-003-X).1999 [cited 2010 December 7]; 11(3): 9-22.
  12. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health; 2004: 920.
  13. Tjepkema, Michael. "Adult obesity."Health Reports (Statistics Canada Catalogue no. 82-003-X).2006 [cited 2010 December 14]; 17(3): 9-25.
  14. World Health Organisation (WHO). Global Status Report on Alcohol 2004. World Health Organization, Geneva, Swizerland; 2004: 88.
  15. Statistics Canada. Leading Causes of Death in Canada, 2007 (Statistics Canada Catalogue no. 84-215-X). 2010 [cited 2011 February 4].
  16. CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. World Health Organization, Geneva, Switzerland. 2008: 256.
  17. Wilkins, Russell, Jean-Marie Berthelot and Edward Ng. "Trends in mortality by neighbourhood income in urban Canada."Supplement to Health Reports (Statistics Canada Catalogue no. 82-003-SIE). 2002 [cited 2010 December 7]; 13: 45–71.

Appendix

Appendix 1 Life Expectancy by health region, 2005 to 2007Appendix 1
Life Expectancy by health region, 2005 to 2007