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

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Socio-economic status and health
Socioeconomic gradients in all-cause, premature and avoidable mortality among immigrants and long-term residents using linked death records in Ontario, Canada
  1. Anam M Khan1,2,
  2. Marcelo Urquia1,2,3,
  3. Kathy Kornas1,
  4. David Henry1,2,
  5. Stephanie Y Cheng2,
  6. Catherine Bornbaum1,4,
  7. Laura C Rosella1,2,5
  1. 1Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  2. 2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  3. 3Centre for Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
  4. 4Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
  5. 5Public Health Ontario, Toronto, Ontario, Canada
  1. Correspondence to Dr Laura Rosella, Dalla Lana School of Public Health, Health Sciences Building 6th floor, 155 College Street Toronto, Ontario, Canada M5T 3M7; laura.rosella{at}utoronto.ca

Abstract

Background Immigrants 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.

Methods Using 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.

Results A 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).

Conclusions This 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.

  • MORTALITY
  • SOCIO-ECONOMIC
  • AVOIDABLE DEATHS

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/jech-2016-208525

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    Footnotes

    • Contributors LR, MU and AMK conceived the manuscript. AMK, KK and SYC prepared data and ran all analyses. DH, LR, MU and CB contributed to the analytic plan and interpretation. AK and LR drafted the manuscript and all authors edited and critically reviewed the final content.

    • Funding This study was funded by the Canadian Institutes for Health Research Operating Grant (FRN-142498). LR is supported by a Canada Research Chair in Population Health Analytics.

    • Competing interests None declared.

    • Ethics approval This study received ethics approval from the University of Toronto's Health Sciences Research Ethics Board and the institutional review board at Sunnybrook Health Sciences Centre, Toronto, Canada.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data set used in this study is held securely in coded format at ICES. Although data sharing agreements prohibit ICES from making the data set publicly available, access may be granted to those who meet the conditions for confidential access, available at http://www.ices.on.ca/Data-Services.