decade after the release of the World Health Organization's final report on the social determinants of health, 1 governments around the world appear to have made relatively little progress toward the goal of reducing health inequalities. In fact, recent epidemiologic findings suggest that socioeconomic inequalities in mortality and related indicators of population health are widening over time. 2-7 Such trends are well established in the United States and Europe, yet analogous trends in Canada remain poorly characterized. Efforts to monitor the evolution of socioeconomic inequalities in mortality in Canada have been hampered by the fact that official death records lack information on the socioeconomic status of deceased people. 8 In the absence of this information, some investigators relied on area-based measures of socioeconomic deprivation to monitor change in mortality inequalities in Canada. 9-13 More recently, however, researchers have overcome this methodologic barrier by linking vital statistics records to individual Census data that contain relevant indicators of socioeconomic status. 14,15 Notably, existing analyses of individual-level trends in the mortality gradient in Canada have focused on the adult population as a whole and, in so doing, have obscured from view an important source of survivorship bias. 14,15 Prior research has shown that those who survive into older adulthood represent a highly selected group and that positive selection for the most robust people is particularly strong at the lower end of the socioeconomic spectrum. 16-20 This pattern of selective survival leads to the gradual convergence of average health levels over time, which, in turn, attenuates the association between socioeconomic status and mortality in older age groups. A common approach to dealing with this form of downward selection bias involves excluding the "oldest old" and focusing attention on socioeconomic inequalities in premature and avoidable mortality among adults younger than age 75 years. 21-25 In the present study, we aimed to examine trends in socioeconomic inequalities in premature and avoidable mortality between 1991 and 2016 in Canada using linked Census and vital registration data.

Background: Approximately 14,000 adults are currently incarcerated in federal prisons in Canada. These facilities are vulnerable to disease outbreaks and an assessment of coronavirus disease 2019 (COVID-19) testing and outcomes is needed. The objective of this study was to examine outcomes of COVID-19 testing, prevalence, case recovery and death within federal prisons and to contrast these data with those of the general population. Methods: Public time-series outcome data for prisoners and the general population were obtained on-line from the Correctional Service of Canada and the Public Health Agency of Canada, respectively, from March 30 to May 27, 2020. Prison, province and sex-specific frequency statistics for each outcome were calculated. A total of 50 facilities were included in this study. Results: Of these 50 facilities, 64% reported fewer individuals tested per 1,000 population than observed in the general population and 12% reported zero tests in the study period. Testing tended to be reactive, increasing only once prisons had recorded positive tests. Six prisons reported viral outbreaks, with three recording over 20% cumulative COVID-19 prevalence among prisoners. Cumulatively, in prisons, 29% of individuals tested received a positive result, compared to 6% in the general population. Two of the 360 cases died (0.6% fatality). Four outbreaks appeared to be under control (more than 80% of cases recovered); however, sizeable susceptible populations remain at risk of infection. Female prisoners (5% of the total prisoner population) were over-represented among cases (17% of cases overall). Conclusion: Findings suggest that prison environments are vulnerable to widespread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Gaps in testing merit public health attention. Symptom-based testing alone may not be optimal in prisons, given observations of widespread transmission. Increased sentinel or universal testing may be appropriate. Increased testing, along with rigorous infection prevention practices and the potential release of prisoners, will be needed to curb future outbreaks.