Advertisement

Canadian Journal of Public Health

, Volume 96, Issue 3, pp 206–211 | Cite as

Income Inequality and Health in Ontario

A Multilevel Analysis
  • Guoliang Xi
  • Ian McDowell
  • Rama Nair
  • Robert Spasoff
Article

Abstract

Objective

To examine the association of income inequality at the public health unit level with individual health status in Ontario.

Methods

Cross-sectional multilevel study carried out among subjects aged 25 years or older residing in 42 public health units in Ontario. Individual-level data drawn from 30,939 respondents in 1996–97 Ontario Health Survey. Median area income and income inequality (Gini coefficient) calculated from 1996 census. Self-rated health status (SRH) and Health Utilities Index (HUI-3) scores were used as main outcomes.

Results

Controlling for individual-level factors including income, respondents living in public health units in the highest tercile of income inequality had odds ratios of 1.20 (95% CI 1.04–1.38) for fair/poor self-rated health, and 1.11 (95% CI 1.01–1.22) for HUI score below the median, compared with people living in public health units in the lowest tercile. Controlling further for median area income had little effect on the association.

Conclusion

Income inequality was significantly associated with individual self-reported health status at public health unit level in Ontario, independent of individual income.

MeSH terms

Income distribution Health Status Index 

Résmé

Objectif

Examiner l’association entre l’inégalité des revenus à l’échelle des unités de santé publique et l’état de santé individuel en Ontario.

Méthode

Étude transversale multiniveau effectuée auprès de sujets de 25 ans et plus desservis par les 42 bureaux de santé publique de l’Ontario. Les données individuelles provenaient des réponses de 30 939 répondants à l’Enquête sur la santé en Ontario (1996–1997). Le revenu médian par zone et l’inégalité des revenus (coefficient de Gini) ont été calculés d’après les données du recensement de 1996. Les principaux résultats que nous avons utilisés ont été les scores obtenus aux chapitres de l’état de santé auto-évalué (ESAE) et du Health Utilities Index (HUI-3).

Résultats

Après les ajustements pour tenir compte des effets de facteurs individuels, dont le revenu, les répondants desservis par les bureaux de santé publique dans le tercile supérieur de l’inégalité des revenus présentaient un risque relatif de 1,20 (IC de 95 % = 1,04–1,38) pour un ESAE moyen ou mauvais, et un risque relatif de 1,11 (IC de 95 % = 1,01–1,22) pour un HUI inférieur à la médiane, par rapport aux personnes desservies par les bureaux de santé publique dans le tercile inférieur. L’apport d’autres ajustements pour tenir compte des effets du revenu médian de la zone a peu modifié cette association.

Conclusion

L’inégalité des revenus présente une corrélation significative avec l’état de santé auto-évalué à l’échelle des bureaux de santé publique en Ontario, quel que soit le revenu personnel.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Wilkinson RG. Income distribution and life expectancy. BMJ 1992;304:165–68.CrossRefGoogle Scholar
  2. 2.
    Kennedy B, Kawachi I, Glass R, Prothrow-Stith D. Income distribution, socioeconomic status, and self-rated health in the United States: Multilevel analysis. BMJ 1998;317:917–21.CrossRefGoogle Scholar
  3. 3.
    Blakely T, Atkinson J, O’Dea D. No association of income inequality with adult mortality within New Zealand: A multilevel study of 1.4 million 25–64 year olds. J Epidemiol Community Health 2003;57:279–84.CrossRefGoogle Scholar
  4. 4.
    Weich S, Lewis G, Jenkins SP. Income inequality and self rated health in Britain. J Epidemiol Community Health 2002;56:436–41.CrossRefGoogle Scholar
  5. 5.
    Chiang T. Economic transition and changing relation between income inequality and mortality in Taiwan: Regression analysis. BMJ 1999;319:1162–65.CrossRefGoogle Scholar
  6. 6.
    Shibuya K, Hashimoto H, Yano E. Individual income, income distribution, and self rated health in Japan: Cross sectional analysis of nationally representative sample. BMJ 2002;324:16–19.CrossRefGoogle Scholar
  7. 7.
    Ross NA, Wolfson MC, Dunn JR, Berthelot JM, Kaplan GA, Lynch JW. Relation between income inequality and mortality in Canada and in the United States: Cross sectional assessment using census data and vital statistics. BMJ 2000;320:898–902.CrossRefGoogle Scholar
  8. 8.
    Kennedy B, Kawachi I, Prothrow-Stith D. Income inequality distribution and mortality: Cross sectional ecological study of the Robin Hood index in the United States. BMJ 1996;312:1004–7.CrossRefGoogle Scholar
  9. 9.
    Kawachi I, Kennedy BP. The relationship of income inequality to mortality: Does the choice of indicator matter? Soc Sci Med 1997;45:1121–27.CrossRefGoogle Scholar
  10. 10.
    Kaplan G, Pamuk E, Lynch J, Cohen R, Balfour J. Inequality in income and mortality in the United States: Analysis of mortality and potential pathways. BMJ 1996;312:999–1003.CrossRefGoogle Scholar
  11. 11.
    Laporte A, Ferguson BS. Income inequality and mortality: Time series evidence from Canada. Health Policy 2003;66:107–17.CrossRefGoogle Scholar
  12. 12.
    McLeod CB, Lavis JN, Mustard CA, Stoddart GL. Income inequality, household income, and health status in Canada: A prospective cohort study. Am J Public Health 2003;93:1287–93.CrossRefGoogle Scholar
  13. 13.
    Yalnizyan A. The Growing Gap: A report on growing inequality between the rich and poor in Canada. Toronto: Centre for Social Justice, 1998.Google Scholar
  14. 14.
    Statistics Canada. 1996 Census Dictionary. Ottawa: Statistics Canada, 1999.Google Scholar
  15. 15.
    Statistics Canada. NPHS Public Use Microdata Documentation 1996–97. Ottawa: Statistics Canada, 1997.Google Scholar
  16. 16.
    Furlong W, Feeny D, Torrance GW, Goldsmith CH, DePauw S, Zhu Z, et al. Multiplicative Multi-Attribute Utility Function for the Health Utilities Index Mark 3 (HUI3) System: A Technical Report. Hamilton, Ontario: McMaster University Centre for Health Economics and Policies Analysis Working Paper No. 98–11, 1998.Google Scholar
  17. 17.
    Rasbash J, Browne W, Goldstein H, Yang M, Plewis I, Healy M, et al. A User’s Guide to MLwiN version 2.1a. Institute of Education, University of London, 2000.Google Scholar
  18. 18.
    Goldstein H, Rasbash J. Improved approximations for multilevel models with binary responses. J Royal Statistical Society 1996;159:505–13.CrossRefGoogle Scholar
  19. 19.
    Joop H. Multilevel Analysis Techniques and Applications. New Jersey: Lawrence Erlbaum Associates, Inc., 2002.Google Scholar
  20. 20.
    Lochner K, Pamuk E, Makuc D, Kennedy BP, Kawachi I. Statelevel income inequality and individual mortality risk: A prospective, multilevel study. Am J Public Health 2001;91:351–53.CrossRefGoogle Scholar
  21. 21.
    Idler EL, Benyamini Y. Self-rated health and mortality: A review of twenty-seven community studies. J Health Soc Behav 1997;38:21–37.CrossRefGoogle Scholar
  22. 22.
    Soobader MJ, LeClere F. Aggregation and the measurement of income inequality: Effects on morbidity. Soc Sci Med 1999;48:733–44.CrossRefGoogle Scholar
  23. 23.
    Boyle M, Willms J. Place effects for areas defined by administrative boundaries. Am J Epidemiol 1999;149:577–85.CrossRefGoogle Scholar
  24. 24.
    Berkman LF, Kawachi I. Social Epidemiology. New York: Oxford University Press, 2000.Google Scholar

Copyright information

© The Canadian Public Health Association 2005

Authors and Affiliations

  • Guoliang Xi
    • 1
  • Ian McDowell
    • 1
  • Rama Nair
    • 1
  • Robert Spasoff
    • 1
  1. 1.Department of Epidemiology and Community MedicineUniversity of OttawaOttawaCanada

Personalised recommendations