Abstract
Objectives: Inequalities in life expectancy between the most and least materially deprived areas in the province of Quebec, Canada are increasing, but the reasons for this trend are unclear. An analysis of which causes of death, in which age groups, are implicated in this trend is necessary to understand it and provide clear targets for intervention.
Methods: We analyzed Québec mortality data for three 4-year periods from 1989-2004. Differences in life expectancy at birth between the most- and least-deprived areas in each period and over time were decomposed by age and cause of death for men and women using the Arriaga method.
Results: Life expectancy increased for all areas, but the increase was smaller in deprived areas. Cancer, heart disease and unintentional injuries accounted for the largest shares of inequality in each period. Among women, the widening life expectancy gap was largely due to increased lung cancer mortality. Among men, mortality from HIV was an important cause of widening inequality. Increasing inequality in both sexes was offset by a decrease in mortality from unintentional injuries in deprived areas (narrowing the gap between the most- and least-deprived areas). The largest share of inequality among women was due to deaths in the 65-and-over age group. Among men, the largest share shifted over time from middle-age to the 65-and-over age group.
Conclusion: The widening life expectancy gap between advantaged and disadvantaged areas in Québec is driven by relatively few causes of death with well-known risk factors and strategies for prevention.
Keywords: Life expectancy, health inequalities, deprivation
Résumé
Objectifs: Les inégalités dans l’espérance de vie entre les régions les plus et les moins défavorisées matériellement sont en hausse dans la province de Québec, au Canada. Nous avons évalué les causes de décès et les groupes d’âge qui ont contribué à cette tendance.
Méthode: Nous avons analysé les données de mortalité au Québec sur trois périodes de quatre ans, de 1989 à 2004. Les différences d’espérance de vie à la naissance entre les régions les plus et les moins défavorisées dans chaque période, et au fil du temps, ont été décomposées par âge et par cause de décès pour les hommes et les femmes en utilisant la méthode d’Arriaga.
Résultats: L’espérance de vie a augmenté dans toutes les régions, mais l’augmentation a été plus faible dans les zones défavorisées. Le cancer, les maladies cardiovasculaires et les blessures involontaires ont le plus contribué aux inégalités dans l’espérance de vie durant chaque période. Chez les femmes, l’élargissement de l’écart d’espérance de vie est largement attribuable à une augmentation de la mortalité par cancer du poumon. Chez les hommes, la mortalité due au VIH est une cause importante de l’élargissement des inégalités. Chez les deux sexes, les inégalités croissantes dans l’espérance de vie sont compensées par une diminution de la mortalité due aux blessures involontaires dans les zones défavorisées (réduisant l’écart entre les régions les plus et les moins défavorisées). La plus grande part des inégalités dans l’espérance de vie des femmes est attribuable aux décès dans le groupe d’âge des 65 ans et plus. Chez les hommes, la plus grande part est passée du groupe des 45 à 64 ans au groupe des 65 ans et plus sur l’ensemble de la période.
Conclusion: L’écart d’espérance de vie entre les zones favorisées et défavorisées au Québec s’élargit en raison d’un assez petit nombre de causes de décès dont les facteurs de risque sont connus et qui peuvent faire l’objet de stratégies de prévention.
Motsclés: espérance de vie, inégalités de santé, défavorisation
Footnotes
Conflict of Interest: None to declare.
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