Preventable hospitalizations and 'deaths of despair' associated with income inequality

Canada's growing income inequality is having an impact on Canadians' mental and physical health, according to public health researchers at the University of Alberta.

In recent research published in the Journal of Epidemiology and Community Health, the team found statistical associations between income inequality and a higher risk of "hospitalizations of despair"—especially drug overdose—and all-cause hospitalizations. Hospitalizations and deaths of despair are defined as being due to drug overdose, suicide attempt or alcohol-related liver disease.

Income inequality isn't only about the prevalence of poverty in a community—it also involves the size of the income gap between the richest and poorest residents, the researchers explain. Income inequality has increased in Canada over the past 20 years, according to the Conference Board of Canada.

"The greater the gap, the greater the likelihood of experiencing a hospitalization due to despair," says principal investigator Roman Pabayo, associate professor in the School of Public Health and Canada Research Chair in Social Environment and Child Health.

"We tracked almost 200,000 people over a 13-year followup in Canada who had these preventable hospitalizations," explains Claire Benny, who carried out the research for her Ph.D. and is now a postdoctoral fellow with Public Health Ontario. "This represents a large burden on the health care system, and on people and their communities."

The research team followed 27.6 million working-aged Canadians in 286 census districts in a population-based longitudinal cohort, linking data from the 2006 Canadian census, the 2007/2008 Canadian Community Health Survey and the 2007–2018 hospital discharge records.

During that time, more than 100,000 people experienced a drug overdose-related hospitalization, 70,000 went to hospital for alcohol-related liver disease and 22,000 were admitted to hospital due to a suicide attempt.

With each district's increase in inequality, the researchers found a 38% increase in overall hospitalizations of despair and a 51% increase in overdoses. The results confirm the team's previous research tracking deaths of despair among Canadian youth, which showed an association between income inequality and an increased risk of deaths of despair, drug overdose and all-cause death.

Even controlling for factors such as mean income, ethnicity, education, or urban versus rural, the results apply to people at all levels of income, the researchers say.

"In communities with high income inequality, it's really hard to feel a sense of connection with your neighbors," says Benny. "You might feel like it's hard to relate or maybe you don't trust those around you, and it works both ways, whether you're a high income earner or a lower income earner. It's a level of uncertainty and disconnect within the space where you spend the majority of your time."

The team hopes their work will inform policy discussions about ways to reduce income inequality and prevent deaths of despair.

"We need more resources in areas with high income inequality, more mental health programming, changes to services for people who use drugs. We want to intervene before it's too late."

Pabayo's research group will continue to build on previous studies on the associations between inequality and health outcomes, including income inequality and odds of online gambling, the use of cannabis, cigarettes and e-cigarettes, and mental health among secondary students. He also intends to explore the potential impact of various wealth redistribution options such as the universal basic income being considered by the Senate Finance Committee.