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Social determinants of ethno-racial inequalities in substance use: a decomposition of national survey data

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Abstract

Background

Similar to the US, mortality due to suicide and the use of opioids, alcohol, and other substances (so-called “Deaths of Despair”), is rising in Canada and has been disproportionately observed among Whites compared to other racial and ethnic groups. This study aimed to assess the determinants of the ethno-racial differences in the use of substances that underlie these deaths.

Methods

Using nationally representative data from the Canadian Community Health Survey (2003, 2015–2016, 2018 cycles), a decomposition analysis was performed to estimate the contribution of psychosocial determinants, including age, sex, marital status, immigration, education, income, rurality, and affective health on inequalities between White and non-White populations in illicit substance, opioid, and problematic alcohol use and combined use (≥ 2) of substances.

Results

Overall, White respondents reported higher levels (by 5% to 10%) of substance use than non-White peers. Over 30% of the ethno-racial inequalities in illicit substance, problematic alcohol, and polysubstance use are explained by the protective role of immigration among those who are not White, whose low levels of substance use lower the prevalence in the non-White population overall. Among those born in Canada, no ethno-racial differences in substance use were observed.

Conclusion

Social determinants, particularly immigrant status, explain a substantial proportion of ethno-racial inequalities in substance use in Canada. The jump in substance use between racialized populations who immigrated to Canada and those Canadian-born highlights the importance of exploring within-group variability in deaths of despair risk and considering how intersecting forces including systemic racism shape substance use patterns across generations.

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Acknowledgements

We would like to thank Z. Zhao for his logistical support for this project. Although the research and analysis are based on data from Statistics Canada, the opinions expressed do not represent the views of Statistics Canada. Note that throughout this study, the term “White” was applied with uppercase lettering, as a proper noun, in acknowledgement of the construction of Whiteness as a racial identity.

Funding

This work was supported by the Fonds de Recherche du Québec–Santé [Postdoctoral Fellowship] and the Canadian Institutes of Health Research [Canada Research Chair in Health Equity].

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Authors and Affiliations

  1. Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada

    Alexandra Blair & Arjumand Siddiqi

  2. Gillings School of Global Public Health, University of North Carolina—Chapel Hill, Chapel Hill, NC, USA

    Arjumand Siddiqi

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  1. Alexandra Blair
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AB–developed the study design, conducted analyses, drafted and reviewed the manuscript. AS–developed the study design, drafted and reviewed the manuscript.

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Correspondence to Alexandra Blair.

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The project was approved by, and data were accessed through and analyzed at, the University of Toronto Research Data Center. Ethics approval was not applicable, as the University of Toronto does not require ethics review for secondary data analysis using Statistics Canada data.

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Blair, A., Siddiqi, A. Social determinants of ethno-racial inequalities in substance use: a decomposition of national survey data. Soc Psychiatry Psychiatr Epidemiol 57, 2013–2022 (2022). https://doi.org/10.1007/s00127-022-02281-3

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