Inequalities in premature deaths have increased between the rich and poor in Canada

Socioeconomic inequalities in premature deaths in Canada have increased over the last 25 years, according to new research published in CMAJ (Canadian Medical Association Journal.

"Although premature mortality rates have declined over time in Canada, those with lower levels of income and education have not benefitted equally from these overall improvements," says Dr. Faraz Vahid Shahidi, Institute for Work and Health, Toronto, Ontario, with coauthors. "As a result of these uneven gains, socioeconomic inequalities in premature mortality have increased in Canada."

To understand how socioeconomic inequalities in premature mortality have changed, researchers analyzed data on adults aged 25-74 years using the Canadian Census Health and Environment Cohorts, which links information from Canada's long-form Census to the Canadian Mortality Database. The study covered the period between 1991 and 2016. Key metrics were socioeconomic status, measured using household income and education, and cause of death.

The relative risk of premature death associated with having a lower income or lower level of education increased steadily over the study period. For example, whereas men in the lowest income group were 110% more likely to die prematurely than their richer counterparts in 1991, they were 180% more likely to die prematurely in 2016. That inequality also increased for lower-income women, who were 70% more likely to die prematurely than their richer counterparts in 1991, but 150% more likely to die prematurely in 2016.

The findings are consistent with those of other international studies that showed increasing mortality gaps between the rich and poor in the United States and Europe.

"We believe that health inequalities are getting worse because underlying social and economic inequalities are getting worse," says Dr. Shahidi. "To resolve health inequalities, governments should pursue policies that will reduce the extent of social and economic inequality in our society, such as raising the minimum wage, improving job security, increasing social assistance rates, and improving access to benefits such as Employment Insurance."

"Trends in socioeconomic inequalities in premature and avoidable mortality in Canada, 1991-2016" is published September 28, 2020.