Socioeconomic gradients in all-cause, premature and avoidable mortality among immigrants and long-term residents using linked death records in Ontario, Canada

Abstract

BackgroundImmigrants have been shown to possess a health advantage, yet are also more likely to reside in arduous economic conditions. Little is known about if and how the socioeconomic gradient for all-cause, premature and avoidable mortality differs according to immigration status.MethodsUsing several linked population-based vital and demographic databases from Ontario, we examined a cohort of all deaths in the province between 2002 and 2012. We constructed count models, adjusted for relevant covariates, to attain age-adjusted mortality rates and rate ratios for all-cause, premature and avoidable mortality across income quintile in immigrants and long-term residents, stratified by sex.ResultsA downward gradient in age-adjusted all-cause mortality was observed with increasing income quintile, in immigrants (males: Q5: 13.32, Q1: 20.18; females: Q5: 9.88, Q1: 12.51) and long-term residents (males: Q5: 33.25, Q1: 57.67; females: Q5: 22.31, Q1: 36.76). Comparing the lowest and highest income quintiles, male and female immigrants had a 56% and 28% lower all-cause mortality rate, respectively. Similar trends were observed for premature and avoidable mortality. Although immigrants had consistently lower mortality rates compared with long-term residents, trends only differed statistically across immigration status for females (p<0.05).ConclusionsThis study illustrated the presence of income disparities as it pertains to all-cause, premature, and avoidable mortality, irrespective of immigration status. Additionally, the immigrant health advantage was observed and income disparities were less pronounced in immigrants compared with long-term residents. These findings support the need to examine the factors that drive inequalities in mortality within and across immigration status.

Changing relative and absolute socioeconomic health inequalities in Ontario, Canada: A population-based cohort study of adult premature mortality, 1992 to 2017

“…These ages align with the definition of premature mortality used by the Canadian Institute for Health Information [23]. They are also consistent with prior analyses of premature mortality that have been carried out in Ontario [18,24] and other similar jurisdictions [25][26][27].…”

“…More evidence is needed to clarify how mortality trends in Canada compare to those in other countries. Relative inequality measures for the Ontario and Canadian populations suggest that, as reported in other countries, socioeconomic inequalities in mortality and premature mortality have risen in recent years [11,18]. Possibly as a result of population aging, crude mortality rates in Canada and Ontario rose between 2013 and 2016; premature mortality, which captures only deaths before age 75, was neither declining nor increasing in Ontario as of 2015 [19,20].…”

Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study

“…Previous research has consistently documented an associa tion between lower income and higher mortality in Canada, 54,55 including greater mortality by unintentional injuries and sui cides. 54,56 However, food insecurity and low income are inher ently different measures of economic wellbeing, with the former capturing experiencebased material hardship and the latter pro viding a relative measure of monetary resources.…”

Differences in ill health and in socioeconomic inequalities in health by ethnic groups: a cross-sectional study using 2011 Scottish census

“…The healthy migrant effect can also explain why some minority groups have lower levels of poor health and low socioeconomic inequalities in health, particularly for younger working age adults (Elstad 2016;Khan et al 2017). We know most of the young minority population (aged 15-44) in Scotland to be recent migrants and thus the results for working age White Polish and Chinese are in line with this theory.…”

“…It has also been previously recorded that socioeconomic inequalities in health tend to be highest among the working age population (ages 30-60) (Norman and Boyle 2014), but again, we do not know whether this applies across ethnicities. The generally better health of young working age (economic) migrants could lead to reduced socioeconomic inequalities in health among the working age population for some ethnicities, as has been suggested by research in Canada (Khan et al 2017).…”