More avoidable deaths in Ontario's poorest neighbourhoods, study finds

TORONTO -- A new study finds that people who live in Ontario's poorest neighbourhoods are more likely to suffer avoidable deaths than those who live in the richest neighbourhoods.

Researchers at ICES, a non-profit research institute that uses population-based health information, found 124,000 avoidable deaths in the "most materially deprived areas" between 1993 and 2014.

That's compared to 66,000 avoidable deaths in the most well-off areas, where average income, education and employment levels were highest.

Preventable deaths include those from lack of timely medical intervention, for instance, or smoking.

Lead author and Ottawa-based family doctor Austin Zygmunt called the gap "huge," and noted the disparity grew even as avoidable deaths in Ontario decreased by almost half -- a drop mostly due to advances in medical treatment of diseases.

"This was even after we considered age, gender and chronic diseases so this is a really concerning finding overall," said Zygmunt, a family doctor in Ottawa who is also a public health & preventive medicine resident at the University of Ottawa.

There were nearly two million deaths in Ontario over the 20-year period -- 25 per cent of which were considered avoidable. Researchers, who included experts from the Ottawa Hospital and Bruyere Research Institute, deemed avoidable deaths that occurred before age 75 as either preventable or treatable.

Twice as many deaths were considered preventable, which could have been avoided by curbing alcohol and/or tobacco use, for instance, or by getting the flu vaccine. Treatable deaths were those due to diseases including pneumonia, high blood pressure, and breast cancer which can benefit from surgery and medical interventions.

While the study did not examine the reasons behind the health gap, Zygmunt said previous studies have shown that income and education levels are big health drivers. But he also cautioned anyone from reading too much into the findings, published Wednesday in the Canadian Journal of Public Health.

"Just because you live in a certain neighbourhood doesn't mean that you will die early, because what determines your health is really complex and includes genetic personal and neighbourhood factors," said Zygmunt.

"Really what this study is reminding us is that we can do a better job as a society because we can predict what types of neighbourhoods will have more avoidable deaths and do something about this."

He said that could include focusing flu vaccine promotion or anti-smoking campaigns on populations most at risk.

Zygmunt noted that the data also suggested progress is being made: the number of avoidable deaths dropped by half in the 20-year study period. The problem is that people living in the most well-off neighbourhoods seem to be benefiting the most.

"We're now able to identify which areas could use a little bit more help and we can continue to promote really good public health policies that will have big impacts on the population," he said as possible solutions.

"Right now, the big things are decreasing alcohol and smoking use, promoting things like vaccinations and continuing to offer treatments and surgeries for medical conditions."

The data also found gender differences among avoidable deaths.

Men were nearly twice as likely to have a preventable death than women, with about 66 per cent of their deaths considered preventable.

"Men tend to have higher rates of smoking and alcohol use and the harms that come from these behaviours and these can lead to earlier deaths," explained Zygmunt, citing previous studies.

Researchers also found that areas with more new immigrants and visible minorities had 20,000 fewer avoidable deaths compared to areas that were not as diverse.

"New immigrants to Canada tend to be healthier than the average Canadian and when you're more healthy you are less likely to have an avoidable death," Zygmunt said.

"But there may also be a role of tight-knit communities and good supports within these groups, which have been shown in other research to be associated with better health outcomes."

A separate study published last week in the Journal of Community Health found the health gap between neighbourhoods increased over the 20-year study period -- in 2014, avoidable deaths in lower-income areas were 2.5 times the rate of those in higher-income areas, an increase from 1993 when it was twice the rate of avoidable deaths.

The Canadian Press first published this article on Dec. 11, 2019.