Paper

Neighbourhood-level marginalization and avoidable mortality in Ontario, Canada: a population-based study

Objective

To examine the impact of neighbourhood marginalization on avoidable mortality (AM) from preventable and treatable causes of death.

Methods

All premature deaths between 1993 and 2014 (N = 691,453) in Ontario, Canada, were assigned to quintiles of neighbourhood marginalization using the four dimensions of the Ontario Marginalization Index: dependency, ethnic concentration, material deprivation, and residential instability. We conducted two multivariate logistic regressions to examine the association between neighbourhood marginalization, first with AM compared with non-AM as the outcome, and second with AM from preventable causes compared with treatable causes as the outcome. All models were adjusted for decedent age, sex, urban/rural location, and level of comorbidity.

Results

A total of 463,015 deaths were classified as AM and 228,438 deaths were classified as non-AM. Persons living in the most materially deprived (OR, 1.24; 95% CI, 1.22 to 1.27) and residentially unstable neighbourhoods (OR, 1.13; 95% CI, 1.11 to 1.15) had greater odds of AM, particularly from preventable causes. Those living in the most dependent (OR, 0.91; 95% CI, 0.89 to 0.93) and ethnically concentrated neighbourhoods (OR, 0.93; 95% CI, 0.91 to 0.93) had lower odds of AM, although when AM occurred, it was more likely to arise from treatable causes.

Conclusion

Different marginalization dimensions have unique associations with AM. By identifying how different aspects of neighbourhood marginalization influence AM, these results may have important implications for future public health efforts to reduce inequities in avoidable deaths.

Presenter

Carrie Shorey, PhD candidate
University of Waterloo

Carrie Shorey is a PhD student in the School of Public Health and Health Systems at the University of Waterloo. She has a particular interest in the areas of stress, inflammation, cognitive decline, and health inequalities. Her past research has looked at how multiple chronic conditions impact cognition in aging adults. Carrie’s current research includes how chronic inflammatory diseases and their pharmacological medications impact cognition and cognitive structures. Carrie is also interested in how chronic stress earlier in life may be associated with cognitive decline in middle age. Carrie completed her MSc at Purdue University and her BA at the University of Guelph.

Author

Dr. Austin Zygmunt, MD, MSc, CCFP
Public Health and Preventive Medicine Residency Program, University of Ottawa

Dr. Austin Zygmunt (he/him) is a fifth year Public Health and Preventive Medicine resident physician at the University of Ottawa and practicing family physician in Ottawa. As a public health resident, Dr. Zygmunt has supported the COVID-19 response at Ottawa Public Health, the Public Health Agency of Canada, and most recently Public Health Ontario. Dr. Zygmunt completed his family medicine residency training at the University of Ottawa in 2018 and has special interests in LGBTQ2I+ health and sexual health. He completed both his medical school and Master’s of Science in Community Health & Epidemiology at Dalhousie University. His research interests include marginalization, health inequities, and preventable health outcomes. His research to examine the association between marginalization and avoidable mortality in Ontario is supported by a grant from the Bruyère Big Data Research Program.