Premature mortality due to social and material deprivation in Nova Scotia, Canada

Abstract

IntroductionInequalities in health attributable to inequalities in society have long been recognized. Typically, those most privileged experience better health, regardless of universal access to health care. Associations between social and material deprivation and mortality from all causes of death— a measure of population health, have been described for some regions of Canada. This study further examines the link between deprivation and health, focusing on major causes of mortality for both rural and urban populations. In addition, it quantifies the burden of premature mortality attributable to social and material deprivation in a Canadian setting where health care is accessible to all.MethodsThe study included 35,266 premature deaths (1995–2005), grouped into five causes and aggregated over census dissemination areas. Two indices of deprivation (social and material) were derived from six socioeconomic census variables. Premature mortality was modeled as a function of these deprivation indices using Poisson regression.ResultsPremature mortality increased significantly with increasing levels of social and material deprivation. The impact of material deprivation on premature mortality was similar in urban and rural populations, whereas the impact of social deprivation was generally greater in rural populations. There were a doubling in premature mortality for those experiencing a combination of the most extreme levels of material and social deprivation.ConclusionsSocioeconomic deprivation is an important determinant of health equity and affects every segment of the population. Deprivation accounted for 40% of premature deaths. The 4.3% of the study population living in extreme levels of socioeconomic deprivation experienced a twofold increased risk of dying prematurely. Nationally, this inequitable risk could translate into a significant public health burden.

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“…Life expectancy rose from 35.8 years for men and 40 years for women in 1920 to 73.3 for men and 80.1 for women in 2001, adding 37.5 and 40.1 years of expected life for men and women, respectively (Pordata 2015). However, even under such propitious conditions, health disparities and inequities have persisted into the present, as reported everywhere (Mackenbach 2006;Clarck 2011;Saint-Jacques et al 2014). …”

“…Deprivation, broadly understood as a disadvantage in living, work and leisure conditions (Townsend 1987), has been one of the most extensively studied social determinants of health. Within European countries, many systematic inequalities in health are related to socioeconomic status and occur between social classes and areas, with most deprived population groups and neighborhoods having worse health and higher mortality (Sridharan et al 2001;Nolasco et al 2009;Yngwe et al 2012, Saint-Jacques et al 2014. These inequalities in health have been observed across the social hierarchy, not only at the extremes 4 (Charlton 1994;Marmot 2010), highlighting the need to focus research and actions on the entire gradient, not just on the bottom groups.…”

“…This persistent dyssynchrony has led to the development of several studies that have consistently noted the role of social factors in the emergence and maintenance of such inequities (Navarro 2009;Marmot 2010;Clarck 2011;Yngwe et al 2012;Saint-Jacques et al 2014). Deprivation, broadly understood as a disadvantage in living, work and leisure conditions (Townsend 1987), has been one of the most extensively studied social determinants of health.…”

Variation in Maternal Co‐morbidities and Obstetric Interventions across Area‐Level Socio‐economic Status: A Cross‐Sectional Study

“…Area‐level SES, an aggregation of individual's SES at a certain geographical level, reflects the social and economic development of a residential area, and influences health by determining exposure to health damaging or protective factors . Several studies have demonstrated that people living in areas with low SES experience higher rates of morbidities, mortalities, and disabilities . In Canada, 40% of premature deaths are accounted for by low area‐level SES .…”

“…Several studies have demonstrated that people living in areas with low SES experience higher rates of morbidities, mortalities, and disabilities . In Canada, 40% of premature deaths are accounted for by low area‐level SES . Similarly, people residing in lower SES areas are more likely to make an emergency department visit or be hospitalised .…”