Avoidable Mortality Rates Decrease but Inequity Gaps Widen for Marginalized Neighborhoods: A Population-Based Analysis in Ontario, Canada from 1993 to 2014

Zygmunt, Austin; Kendall, Claire; James, Paul D.; Lima, Isac; Tuna, Meltem; Tanuseputro, Peter

doi:10.1007/s10900-019-00778-8

Cited by 15 publications

(9 citation statements)

References 17 publications

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“…Studies have previously linked material hardship, shortage of basic material needs, and social exclusion to increased mortality from diabetes, cancer, lung disease, and heart disease. 55 , 56 , 57 , 58 , 59 , 60 , 61 Results of our study extend these findings by demonstrating that residing in neighborhoods with higher residential instability and lower material resources can substantially impede achievement of ideal CVH in those not yet diagnosed with heart disease. Therefore, the social environment may be a key target for CVH health promotion and CVD prevention.…”

Section: Discussionsupporting

confidence: 73%

Influence of the Social Environment on Ideal Cardiovascular Health

Singh

Stranges

Wilk

et al. 2023

JAHA

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Background The environment plays a large role in the health of individuals; however, more research is needed to better understand aspects of the environment that most influence health. Specifically, our study examines how the social environment influences cardiovascular health (CVH). Methods and Results The social environment was characterized using measures of belonging and life and work stress in individuals, as well as nationally derived measures of marginalization, deprivation, economic status, and community well‐being in neighborhoods. CVH was defined by the American Heart Association's Cardiovascular Health Index—a summed score of 7 clinical and behavioral components known to have the greatest impact on CVH. Data were obtained from the Canadian Community Health Survey 2015 to 2016 and multiple national data sources. Multilevel regression models were used to analyze the associations between CVH and the social environment. Overall, 27% of Canadians reported ideal CVH (6–7 score points), 68% reported intermediate CVH (3–5 score points), and 5% reported poor CVH (0–2 score points). The neighborhood environment contributed up to 7% of the differences in CVH between individuals. Findings indicated that residing in a neighborhood with greater community well‐being (odds ratio [OR], 1.33 [95% CI, 1.26–1.41]) was associated with achieving higher odds of ideal CVH, while weaker community belonging (OR, 0.67 [95% CI, 0.62–0.72]) and residing in a neighborhood with greater marginalization (OR, 0.87 [95% CI, 0.82–0.91]) and deprivation (OR, 0.67 [95% CI, 0.64–0.69]) were associated with achieving lower odds of ideal CVH. Conclusions Aspects of individual‐level social environment and residing in a neighborhood with a more favorable social environment were both independently and significantly associated with achieving ideal CVH.

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Section: Discussionsupporting

confidence: 73%

Influence of the Social Environment on Ideal Cardiovascular Health

Singh

Stranges

Wilk

et al. 2023

JAHA

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“…For example, between 1993 and 2014, the likelihood of dying from a preventable cause increased more than twofold when comparing Ontario's poorest and most affluent neighbourhoods. 1 These differences come with the human cost of thousands of avoidable deaths every year and are particularly harrowing for Indigenous Peoples. The persistence of these dis parities amounts to discrimination against Canada's most dis advantaged populations.…”

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confidence: 99%

The mirage of universality: Canada’s failure to act on social policy and health care

Boozary

Laupacis

2020

CMAJ

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“…For example, individuals experiencing homelessness in Toronto have been reported to face greater unmet healthcare needs compared to the city's general population, 23 and wide disparities in avoidable mortality rates have been demonstrated between the least and most marginalized neighbourhoods in Ontario. 24,25 In particular, we found only one study that focused on Indigenous populations, which could suggest a research gap in this area. Future studies should explore the association between physician characteristics and population served in a Canadian setting in order to optimize health human resources in a way that contributes to a more equitable health care system.…”

Section: Discussionmentioning

confidence: 89%

Characteristics of Canadian physicians and their associations with practice patterns: a scoping review

et al. 2022

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Background: Physician characteristics such as education and sociodemographic attributes are associated with particular practice patterns, such as practice in rural settings. Understanding the Canadian context of such associations can inform medical school recruitment and health workforce decision-making. Objective: The objective of this scoping review was to report the nature and extent of the literature on associations between characteristics of physicians in Canada and physicians’ practice patterns. Eligibility criteria: We included studies reporting associations between 1) the education or sociodemographic attributes of practicing physicians or residents in Canada and 2) practice patterns, including career choice, practice setting, and populations served. Methods: We searched five electronic databases (MEDLINE (R) ALL, Embase, ERIC, Education Source and Scopus) for quantitative primary studies and reviewed reference lists of included studies for additional studies. Data were extracted using a standardized data charting form. Results: Our search yielded 80 studies. Sixty-two examined education, evenly divided between undergraduate and postgraduate. Fifty-eight examined physicians’ attributes, most focusing on sex/gender. The majority of studies focused on the outcome of practice setting. We found no studies examining race/ethnicity or socioeconomic status. Conclusion: Many studies in our review found positive associations between (i) rural training or rural background and rural practice setting and (ii) location of training or physicians’ origin and practice in that location, consistent with previous literature. Associations for sex/gender were mixed, suggesting it may be a less useful target for workforce planning or recruitment aiming to address gaps in health care provision. More research is needed on the association of characteristics, particularly race/ethnicity and socioeconomic status, with career choice and populations served.

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Avoidable Mortality Rates Decrease but Inequity Gaps Widen for Marginalized Neighborhoods: A Population-Based Analysis in Ontario, Canada from 1993 to 2014

Cited by 15 publications

References 17 publications

Influence of the Social Environment on Ideal Cardiovascular Health

Influence of the Social Environment on Ideal Cardiovascular Health

The mirage of universality: Canada’s failure to act on social policy and health care

Characteristics of Canadian physicians and their associations with practice patterns: a scoping review

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