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The 2011 and 2016 iterations of the Ontario Marginalization Index: updates, consistency and a cross-sectional study of health outcome associations

Abstract

Objectives

The Ontario Marginalization Index (ON-Marg) is an area-based measure used widely to measure health inequalities in Ontario. Recently, the index was updated for 2011 and 2016. The loss of the 2011 long-form census required the use of alternative data sources for the 2011 version. This paper describes the update of ON-Marg, assesses consistency in the indices across census years using Dissemination Areas, and examines associations between ON-Marg 2016 and four health and social outcomes to demonstrate its potential to measure health inequalities.

Methods

ON-Marg was created using factor analysis. Differences in quintile assignment was compared over time to assess whether the use of taxfiler, immigration, property assessment, and health card address data in 2011 affected consistency in measurement of marginalization. Inequalities in rates of overall mortality, gonorrhea incidence, mental health emergency department visits, and alcohol retail locations across quintiles of ON-Marg 2016 were quantified using the Relative Index of Inequality.

Results

Depending on the dimension, between 81% and 96% of DAs showed limited or no changes in quintiles of marginalization between 2006, 2011 and 2016. Of the 45–64% of DAs that did not change quintile between 2006 and 2016, 1.8% to 8.8% of DAs in 2011 differed by two or more quintiles. Findings showed significant differences in rates of health and social outcomes across quintiles of ON-Marg 2016, with strength and directionality varying by dimension of ON-Marg.

Conclusion

Alternative data sources did not substantially affect the consistency of the 2011 version of ON-Marg. The updated ON-Marg is a comprehensive tool that can be used to study health inequalities in Ontario.

Résumé

Objectifs

L’indice de marginalisation ontarien (indice ON-Marg) est un indicateur par secteurs largement utilisé pour mesurer les inégalités en santé dans la province. Il a récemment été mis à jour pour 2011 et 2016. Avec l’élimination du recensement long en 2011, il a fallu se tourner vers d’autres sources de données. Le présent article décrit la mise à jour de l’indice ON-Marg, évalue l’uniformité des indices d’un recensement à l’autre d’après les aires de diffusion, et examine les liens entre l’indice ON-Marg 2016 et quatre résultats en matière de santé et sur le plan social pour illustrer son potentiel à mesurer les inégalités en santé.

Méthodologie

L’indice ON-Marg a été créé selon les principes de l’analyse factorielle. Ont été comparés au fil du temps les écarts entre les quintiles pour évaluer si l’utilisation en 2011 des données des déclarants, d’immigration et d’évaluation foncière et celles des adresses des cartes Santé avait eu une incidence sur l’uniformité de la mesure de la marginalisation. Les inégalités quant au taux global de mortalité, à l’incidence de la gonorrhée, au nombre de visites dans les services d’urgence pour des raisons de santé mentale et à l’emplacement des magasins de vente au détail d’alcool par quintiles de l’indice ON-Marg 2016 ont été quantifiées au moyen de l’indice d’inégalité relative.

Résultats

Selon l’aspect, il y avait peu ou pas de changements dans 81 % à 96 % des aires de diffusion pour les quintiles de marginalisation de 2006, 2011 et 2016. Parmi les aires de diffusions qui n’ont pas changé de quintile de 2006 à 2016 (45 % à 64 % d’entre elles), on a observé un écart de deux quintiles ou plus en 2011 dans 1,8 % à 8,8 % des cas. L’étude témoigne d’un écart significatif dans les taux des résultats en matière de santé et sur le plan social pour l’ensemble des quintiles de l’indice ON-Marg 2016, la force et la direction variant en fonction de l’aspect.

Conclusion

L’utilisation d’autres sources de données n’a pas eu de grande incidence sur l’uniformité de la version 2011 de l’indice ON-Marg. La dernière version mise à jour est un outil complet pouvant servir à étudier les inégalités en santé en Ontario.

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References

  1. Boyd, P. A., Armstrong, B., Dolk, H., Botting, B., Pattenden, S., Abramsky, L., et al. (2004). Congenital anomaly surveillance in England—ascertainment deficiencies in the national system. BMJ, 330(7481), 27. https://doi.org/10.1136/bmj.38300.665301.3A.

    Article  PubMed  Google Scholar 

  2. Bryere, J., Pornet, C., Copin, N., Launay, L., Gusto, G., Grosclaude, P., et al. (2016). Assessment of the ecological bias of seven aggregate social deprivation indices. BMC Public Health, 17(1), 86. https://doi.org/10.1186/s12889-016-4007-8.

    Article  Google Scholar 

  3. Bushnik, T., Tjepkema, M., & Martel, L. (2020). Socioeconomic disparities in life and health expectancy among the household population in Canada. Health Reports. Ottawa: Catalogue no. 82-003-X.

  4. Collins, S. E. (2016). Associations between socioeconomic factors and alcohol outcomes. Alcohol Research: Current Reviews, 38(1), 83–94.

    Google Scholar 

  5. Elliott, J., Gale, C. R., Parsons, S., Kuh, D., & Team, H. S. (2014). Neighbourhood cohesion and mental wellbeing among older adults: a mixed methods approach. Social Science & Medicine, 107, 44–51.

    Article  Google Scholar 

  6. Forer, B., Minh, A., Enns, J., Webb, S., Duku, E., Brownell, M., et al. (2020). A Canadian neighbourhood index for socioeconomic status associated with early child development. Child Indicators Research. https://doi.org/10.1007/s12187-019-09666-y.

  7. Gamache, P., & Hamel, D. (2017). The challenges of updating the deprivation index with data from the 2011 Census and the National Household Survey (NHS). Institut national de santé publique du Québec

  8. Hansson, E. K., Tuck, A., Lurie, S., & McKenzie, K. (2012). Rates of mental illness and suicidality in immigrant, refugee, ethnocultural, and racialized groups in Canada: A review of the literature. The Canadian Journal of Psychiatry, 57(2), 111–121.

    Article  Google Scholar 

  9. Kim, J., & Mueller, C. (1978a). Factor analysis: Statistical methods and practical issues. Sage Publications.

  10. Kim, J., & Mueller, C. (1978b). Introduction to factor analysis: What it is and how to do it. CA: Sage Publications.

  11. Kivimäki, M., Batty, G. D., Pentti, J., Shipley, M. J., Sipilä, P. N., Nyberg, S. T., et al. (2020). Association between socioeconomic status and the development of mental and physical health conditions in adulthood: A multi-cohort study. The Lancet Public Health, 5(3), e140–e149.

    Article  Google Scholar 

  12. Lachaud, J., Donnelly, P., Henry, D., Kornas, K., Fitzpatrick, T., Calzavara, A., et al. (2018). Characterising violent deaths of undetermined intent: A population-based study, 1999-2012. Injury Prevention, 24(6), 424–430. https://doi.org/10.1136/injuryprev-2017-042376.

    Article  PubMed  Google Scholar 

  13. Lu, C., & Ng, E. (2019). Healthy immigrant effect by immigrant category in Canada. Health Reports, Catalogue no. 82-003-X

  14. Matheson, F. I., Dunn, J. R., Smith, K. L. W., Moineddin, R., & Glazier, R. H. (2012a). Ontario Marginalization Index user guide. Centre for Research in Inner City Health, St Michael’s Hospital.

  15. Matheson, F. I., Dunn, J. R., Smith, K. L. W., Moineddin, R., & Glazier, R. H. (2012b). Canadian Marginalization Index user guide. Centre for Research in Inner City Health, St Michael’s Hospital

  16. Matheson, F. I., Dunn, J. R., Smith, K. L. W., Moineddin, R., & Glazier, R. H. (2012c). Development of the Canadian Marginalization Index: A new tool for the study of inequality. Canadian Journal of Public Health, 103, S12–S16 www.jstor.org/stable/41995683.

    Article  Google Scholar 

  17. Moin, J. S., Moineddin, R., & Upshur, R. E. G. (2018). Measuring the association between marginalization and multimorbidity in Ontario, Canada: A cross-sectional study. Journal of Comorbidity, 8(1) 2235042X18814939. https://doi.org/10.1177/2235042X18814939.

  18. Moreno-Betancur, M., Latouche, A., Menvielle, G., Kunst, A. E., & Rey, G. (2015). Relative index of inequality and slope index of inequality: A structured regression framework for estimation. Epidemiology, 26(4), 518–527. https://doi.org/10.1097/ede.0000000000000311.

    Article  PubMed  Google Scholar 

  19. Myran, D. T., Chen, J. T., Giesbrecht, N., & Rees, V. W. (2019). The association between alcohol access and alcohol-attributable emergency department visits in Ontario, Canada. Addiction, 114(7), 1183–1191.

    Article  Google Scholar 

  20. Peel Public Health. (2011). Health in Peel: Determinants and disparities. Region of Peel. https://www.peelregion.ca/health/health-status-report/determinants/pdf/MOH-0036_Determinants_final.pdf. Accessed 1 June 2020.

  21. Pinault, L., Khan, S., & Tjepkema, M. (2020). Accuracy of matching residential postal codes to census geography. Health Reports, 31(3), 3–13. https://doi.org/10.25318/82-003-x202000300001-eng.

    Article  PubMed  Google Scholar 

  22. Robinette, J. W., Charles, S. T., Mogle, J. A., & Almeida, D. M. (2013). Neighborhood cohesion and daily well-being: Results from a diary study. Social Science & Medicine, 96, 174–182.

    Article  Google Scholar 

  23. Rossen, L. M. (2014). Neighbourhood economic deprivation explains racial/ethnic disparities in overweight and obesity among children and adolescents in the USA. Journal of Epidemiology and Community Health, 68(2), 123. https://doi.org/10.1136/jech-2012-202245.

    Article  PubMed  Google Scholar 

  24. Sánchez-Santos, M. T., Mesa-Frias, M., Choi, M., Nüesch, E., Asunsolo-Del Barco, A., Amuzu, A., et al. (2013). Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies. PLoS One, 8(9), e72656–e72656. https://doi.org/10.1371/journal.pone.0072656.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. Shah, B. R., Chiu, M., Amin, S., Ramani, M., Sadry, S., & Tu, J. V. (2010). Surname lists to identify South Asian and Chinese ethnicity from secondary data in Ontario, Canada: A validation study. BMC Medical Research Methodology, 10(1), 42.

    Article  Google Scholar 

  26. Silverman, J. D., Hutchison, M. G., & Cusimano, M. D. (2013). Association between neighbourhood marginalization and pedestrian and cyclist collisions in Toronto intersections. Canadian Journal of Public Health, 104(5), e405–e409. https://doi.org/10.17269/cjph.104.4053.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Simons, E., Dell, S. D., Moineddin, R., & Toe, T. (2019). Neighborhood material deprivation is associated with childhood asthma development: Analysis of prospective administrative data. Canadian Respiratory Journal, 2019, 6808206. https://doi.org/10.1155/2019/6808206.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Statistics Canada. (2011). Income reference guide national household survey. Statistics Canada Catalogue no. 99-014-X2011006.

  29. Tobias, M. I., & Cheung, J. (2003). Monitoring health inequalities: Life expectancy and small area deprivation in New Zealand. Population Health Metrics, 1(1), 2. https://doi.org/10.1186/1478-7954-1-2.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Zygmunt, A., Tanuseputro, P., James, P., Lima, I., Tuna, M., & Kendall, C. E. (2020). Neighbourhood-level marginalization and avoidable mortality in Ontario, Canada: A population-based study. Canadian Journal of Public Health, 111(2), 169–181. https://doi.org/10.17269/s41997-019-00270-9.

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was supported by Public Health Ontario, MAP Centre for Urban Health Solutions, St. Michael’s Hospital, and Dalla Lana School of Public Health, University of Toronto. The creation of the 2011 ON-Marg Index was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). The opinions, results and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES, MOH or MLTC is intended or should be inferred. Parts of ON-Marg 2011 are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI) and Immigration, Refugees and Citizenship Canada (IRCC). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors, and not necessarily those of MOH, MLTC, CIHI or IRCC. The authors wish to thank Gary Moloney for his contributions to ON-Marg 2016 and Aya Mahder Bashi for her contributions to the gonorrhea incidence analysis.

Availability of data and material

The Ontario Marginalization Index is available at https://www.publichealthontario.ca/en/data-and-analysis/health-equity/ontario-marginalization-index or http://www.ontariohealthprofiles.ca/onmargON.php. All other data used in this study are not publicly available.

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Contributions

TVI and FM conceived and drafted the manuscript. TVI created the analytic plan and ran all analyses. All the authors edited, critically reviewed and approved the final content of the manuscript.

Corresponding author

Correspondence to Trevor van Ingen.

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The authors declare no competing interests.

Ethics approval

This study was approved by the Research Ethics Board of St. Michael’s Hospital (#16-016) and the Ethics Review Board of Public Health Ontario (#2016-016.03).

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Appendix

Appendix

Table. 5 ICD-10 codes for selected mental illnesses

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van Ingen, T., Matheson, F.I. The 2011 and 2016 iterations of the Ontario Marginalization Index: updates, consistency and a cross-sectional study of health outcome associations. Can J Public Health (2021). https://doi.org/10.17269/s41997-021-00552-1

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Keywords

  • Health equity
  • Health status disparities
  • Health status indicators
  • Marginalization
  • Methods
  • Ontario / Epidemiology

Mots-clés

  • Équité en santé
  • disparités de l’état de santé
  • indicateurs de l’état de santé
  • marginalisation
  • méthodes
  • Ontario/épidémiologie