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Avoidable Mortality Rates Decrease but Inequity Gaps Widen for Marginalized Neighborhoods: A Population-Based

Austin Zygmunt1, Claire E Kendall2,3,4,5,6, Paul James3,7

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|November 14, 2019
PubMed
Summary

Avoidable mortality (AM) rates declined significantly in Ontario, but the gap between the most and least marginalized neighborhoods widened. Addressing preventable deaths in highly marginalized areas is crucial for further reductions.

Keywords:
Avoidable mortalityDependencyEthnic concentrationMarginalizationMaterial deprivationResidential instability

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Area of Science:

  • Public Health
  • Health Equity Research
  • Epidemiology

Background:

  • Avoidable mortality (AM) is a key indicator of healthcare and public health system effectiveness.
  • Marginalized populations disproportionately experience higher rates of AM.
  • Understanding AM trends across different levels of neighborhood marginalization is essential for targeted interventions.

Purpose of the Study:

  • To examine trends in avoidable mortality (AM) rates in Ontario between 1993 and 2014.
  • To assess how these trends vary by neighborhood marginalization, using the Ontario Marginalization (ON-Marg) Index.
  • To quantify the widening inequity gap in AM between the most and least marginalized quintiles over time.

Main Methods:

  • Utilized a population-based cohort of 691,453 decedents under age 75 in Ontario (1993-2014).
  • Assigned decedents to quintiles of the ON-Marg Index dimensions: material deprivation, residential instability, dependency, and ethnic concentration.
  • Calculated age- and sex-standardized AM incidence rates and rate ratios comparing the most (Q5) and least (Q1) marginalized quintiles.

Main Results:

  • Overall AM rates in Ontario decreased by 48.6% from 1993 to 2014 (216 to 111 per 100,000 population).
  • The decline was more pronounced for treatable AM than preventable AM.
  • The inequity gap, measured by the Q5/Q1 rate ratio, widened across all marginalization dimensions, particularly for dependency, material deprivation, and residential instability.

Conclusions:

  • Despite an overall decline in avoidable mortality, significant inequities persist and have widened.
  • Targeted public health and policy interventions are urgently needed to address preventable deaths in highly marginalized neighborhoods.
  • Future efforts must focus on the specific dimensions of marginalization contributing most to the widening AM inequity gap.