Trends in Mortality by Income in Urban Canada from 1971 to 1996.

PART II

Russell Wilkins, Edward Ng and Jean-Marie Berthelot

Health Analysis and Modeling GroupStatistics Canada, Ottawa

Session 65:

Causes of Death Analyses, Differentials and Trends Population Association of America (PAA)

2001 Annual Meeting, Washington DC 29-31 March 2001

Russell Wilkins

Health Analysis and Modeling Group

Statistics Canada, RHC-24A

Ottawa ON K1A OT6

Tel: 1-613-951-5305 Fax: 1-613-951-3959

Email: russell.wilkins@statcan.ca

Trends by Cause, ASMR-All Ages

• Progress towards the goal of Health for All– Lower mortality

– Less inequality

• Lack of progress– Little change in mortality

– Less inequality but higher mortality

• Worsening– Higher mortality

– Greater inequality

Perinatal Conditions

0123456789

10111213141516

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Ischemic Heart Disease

020406080

100120140160180200220240260280300320340360380400420

1971 1976 1981 1986 1991 1996

Q1-M RichestQ2-MQ3-MQ4-MQ5-M PoorestQ1-F RichestQ2-FQ3-FQ4-FQ5-F Poorest

ASMR per 100,000

Ischemic Heart Disease, Males

100120140160180200220240260280300320340360380400420

1971 1976 1981 1986 1991 1996

Q1-M Richest

Q2-M

Q3-M

Q4-M

Q5-M Poorest

Per 100,000

Ischemic Heart Disease, Females

50

60

70

80

90

100

110

120

130

140

150

160

170

1971 1976 1981 1986 1991 1996

Q1-F Richest

Q2-F

Q3-F

Q4-F

Q5-F Poorest

ASMR per 100,000

Uterine Cancer

0123456789

1011121314

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Liver Cirrhosis, Females

0

1

2

3

4

5

6

7

8

9

10

11

12

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Liver Cirrhosis, Males

02468

1012141618202224262830

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Injuries except MVTA+Suicide, Both Sexes

0

5

10

15

20

25

30

35

40

45

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Pedestrians Hit by Motor Vehicles, Both Sexes

0

1

2

3

4

5

6

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Motor Vehicle Occupants, Both Sexes

0

2

4

6

8

10

12

14

16

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Lung Cancer, Males

05

101520253035404550556065707580859095

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Breast Cancer, Females

02468

101214161820222426283032

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Prostate Cancer

02468

101214161820222426

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Suicide, Males

02468

10121416182022242628303234

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Suicide, Females

0

1

2

3

4

5

6

7

8

9

10

11

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Lung Cancer, Females

0

5

10

15

20

25

30

35

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Mental Disorders, Both Sexes

0

1

2

3

4

5

6

7

8

9

10

11

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Infectious Diseases, Both Sexes

0

2

4

6

8

10

12

14

16

18

20

22

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Includes 1986 AIDS recoded to Infectious Diseases

Ill-Defined Conditions, Both Sexes

0

2

4

6

8

10

12

14

16

18

20

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Diabetes, Males

0

2

4

6

8

10

12

14

16

18

20

22

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Diabetes, Females

0

2

4

6

8

10

12

14

16

18

20

22

1971 1976 1981 1986 1991 1996

Q1 - Richest

Q2

Q3

Q4

Q5 - Poorest

ASMR x 100,000

Conclusions: Trends 1971-1996

• Lower mortality for all income quintiles, both sexes, and for most causes

• Persistence of an income gradient, though less steep than formerly• affects females as well as males, though less sharply

• highest relative risks in working ages (25-64)

• Elimination of the remaining disparities would result in gains in potential years of life equivalent to

eradicating one of the three leading causes of death

Conclusions: Trends 1971-1996 (cont.)

• Throughout this period, there were substantially diminished differences across the income quintiles, overall and for most causes of death

• many causes showed remarkable progress: reduced mortality and diminished differences

• a few causes showed higher mortality and greater inequality

• timing of the changes varied by cause