Neighbourhood-level marginalization and avoidable mortality in Ontario, Canada: a population-based study

Area of Science:

• Public Health
• Social Epidemiology
• Health Equity

Background:

• Avoidable mortality (AM) represents deaths that could have been prevented or treated.
• Neighbourhood characteristics are increasingly recognized as social determinants of health.
• Understanding the link between marginalization and AM is crucial for targeted interventions.

Purpose of the Study:

• To investigate the association between neighborhood marginalization and avoidable mortality (AM).
• To differentiate the impact of marginalization on preventable versus treatable causes of AM.
• To explore how various dimensions of marginalization influence AM patterns.

Main Methods:

• Analysis of premature deaths (1993-2014) in Ontario, Canada (N=691,453).
• Assignment of deaths to quintiles of neighborhood marginalization using the Ontario Marginalization Index (dependency, ethnic concentration, material deprivation, residential instability).
• Multivariate logistic regressions adjusted for age, sex, urban/rural status, and comorbidity.

Main Results:

• Higher odds of AM were observed in materially deprived (OR 1.24) and residentially unstable (OR 1.13) neighborhoods.
• AM from preventable causes was particularly associated with material deprivation and residential instability.
• Dependent and ethnically concentrated neighborhoods showed lower AM odds, but AM was more likely from treatable causes.

Conclusions:

• Dimensions of neighborhood marginalization have distinct relationships with AM.
• Identifying these specific associations can inform public health strategies to reduce inequities in avoidable deaths.
• Targeted interventions addressing material deprivation and residential instability may reduce preventable AM.