Abstract
Objective: This study explores the contribution of deprivation, immigration and Aboriginal status to survival in various parts of Canada. It is hypothesized that differences in the magnitude of survival inequalities according to deprivation across Canada are attenuated when immigration and Aboriginal status are accounted for.
Methods: The study is based on a file linking the 1991 census and a follow-up of mortality from 1991 to 2001. Geographic areas are the Canadian regions, the census metropolitan areas (CMAs) of Montréal, Toronto and Vancouver as well as the metropolitan-influenced zones. Deprivation is measured through a Canadian deprivation index. Immigration is based on declared place of birth and Aboriginal status on ethnic origin, registered treaty Indian status and Band or First Nation membership. Survival is modelized through Cox regression and two sets of models are produced for every geographic area.
Results: Survival is associated with deprivation, immigration and Aboriginal status in most parts of Canada. After accounting for immigration and Aboriginal status, differences in the magnitude of survival inequalities related to deprivation across Canada are attenuated. Such inequalities are highly reduced in the Prairies and remote hinterland and slightly increased in the CMA of Toronto. Nevertheless, high survival inequalities related to deprivation remain in Canada, namely in the Prairies and, to a lesser degree, in British Columbia and the CMA of Vancouver.
Conclusion: After accounting for immigration and Aboriginal status, differences in the magnitude of survival inequalities according to deprivation across Canada are attenuated but not completely eliminated.
Key words: Health inequalities, deprivation, immigration, Aboriginal people, survival, Canada
Résumé
Objectifs: Cette étude explore la contribution de la défavorisation, de l’immigration et du statut Autochtone à la survie dans divers milieux géographiques du Canada. L’hypothèse de recherche est la suivante: les différences observées dans l’ampleur des inégalités de survie selon la défavorisation à travers le Canada sont réduites lorsque l’immigration et le statut d’Autochtone sont pris en compte.
Méthode: L’étude repose sur un fichier jumelant le recensement de 1991 et un suivi de la mortalité de 1991 à 2001. Les milieux géographiques sont les régions canadiennes, les régions métropolitaines de recensement (RMR) de Montréal, Toronto et Vancouver et les zones d’influence métropolitaine. La défavorisation est mesurée par un indice canadien de défavorisation. L’immigration est fondée sur le lieu de naissance et le statut d’Autochtone sur l’origine ethnique, le statut d’Indien inscrit ou d’Indien des traités, et l’appartenance à une bande ou à une Première nation. La survie est modélisée par la régression de Cox et deux modèles sont produits pour chaque milieu géographique.
Résultats: La survie est associée à la défavorisation, l’immigration et le statut Autochtone presque partout au Canada. Après contrôle de l’immigration et du statut Autochtone, les différences notées dans l’ampleur des inégalités de survie selon la défavorisation entre milieux géographiques au Canada sont réduites. De telles inégalités sont fortement atténuées dans les Prairies et l’arrière-pays rural et légèrement amplifiées dans la RMR de Toronto. Il reste cependant de grandes disparités de survie reliées à la défavorisation au Canada, notamment dans les Prairies et, à un degré moindre, en Colombie-Britannique et dans la RMR de Vancouver.
Conclusion: En tenant compte de l’immigration et du statut Autochtone, les différences observées dans l’ampleur des inégalités de survie selon la défavorisation à travers le Canada sont réduites mais non complètement éliminées.
Mots clés: Inégalités de santé, défavorisation, immigration, peuples Autochtones, survie, Canada
Footnotes
Conflict of Interest: None to declare.
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