Recent changes in the geography of social disparities in premature mortality in Québec
Section snippets
Geographic settings
The selected geographic settings are part of the new statistical area classification (SAC) developed by Statistics Canada in 2001 for data dissemination purposes (Statistics Canada, 2003). The SAC groups census subdivisions (municipalities) according to whether they are a component of a census metropolitan area (CMA), a census agglomeration (CA), or a CMA and CA influenced zone (MIZ). A CMA or CA is an area consisting of one or more adjacent municipalities situated around a major urban core. To
Results
In Québec between 1989–1993 and 1999–2003, the premature mortality rate dropped by 15%, from 384 to 325 per 100,000 persons. Premature mortality decreased in every geographic setting but mainly in the CMA of Montréal and in ‘other CMAs’ (Fig. 1). Mid-size cities, small towns and rural areas, which already had higher mortality rates in 1989–1993, increased their relative disadvantage.
A look at changes in premature mortality among the most and least deprived groups reveals that rates declined
Discussion
In recent years, the geography of social disparities in premature mortality has changed substantially in Québec. Social disparities have increased everywhere except in the CMA of Montréal. This CMA still exhibits high inequalities, but it now shares the highest rate ratio with ‘other CMAs’ and the highest rate difference with ‘other CMAs’ and mid-size cities. Furthermore, the most deprived groups living in the CMA of Montréal still have a high premature mortality rate, but this rate is now
Conclusion
This study remains exploratory. Its aim is to describe the recent evolution of social inequalities in mortality in four geographic settings and to suggest hypotheses on the factors underlying this evolution. Clearly, recent changes in social gaps in mortality vary by geographic setting, and results show that, contrary to what was expected, social inequalities are increasing everywhere in Québec except in its major urban center, the CMA of Montréal. With the data available, we went as far as
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