Canadian Journal of Public Health

, Volume 104, Issue 7, pp e472–e478 | Cite as

Socio-economic Inequalities in Cause-specific Mortality: A 16-year Follow-up Study

  • Michael TjepkemaEmail author
  • Russell Wilkins
  • Andrea Long
Quantitative Research



To examine socio-economic inequalities in cause-specific mortality by examining the independent effects of education, occupation and income in a population-based study of working-age Canadian adults.


This is a secondary analysis of data from the 1991–2006 Canadian Census mortality and cancer follow-up study (n=2.7 million persons). For this analysis, the cohort was restricted to 2.3 million persons aged 25 to 64 at cohort inception, of whom 164,332 died during the follow-up period. Hazard ratios were calculated by educational attainment (4 levels), occupational skill (6 categories) and income adequacy (5 quintiles) for all-cause mortality and major causes of death. Models were run separately for men and women, controlled for multiple variables simultaneously, and some were stratified by 10-year age cohorts.


The magnitude of socio-economic inequalities in mortality differed by indicator of socio-economic position (education, occupation, or income), age group, sex, and cause of death. Compared to age-adjusted models, hazard ratios were attenuated but remained significant in models that adjusted for both age and all three indicators of socio-economic position simultaneously. Socio-economic inequalities in mortality were evident for most of the major causes of death examined.


This study demonstrates that education, occupation and income were each independently associated with mortality and were not simply proxies for each other. When evaluating socio-economic inequalities in mortality, it is important to use different indicators of socio-economic position to provide a more complete picture.

Key words

Canada/epidemiology socioeconomic factors mortality 



Étudier les inégalités socioéconomiques influant sur la mortalité selon la cause en examinant les effets indépendants du niveau de scolarité, de la profession et du revenu dans le cadre d’une étude basée sur la population d’adultes canadiens en âge de travailler.


Il s’agit d’une analyse secondaire des données de l’étude canadienne de suivi de la mortalité et du cancer selon le recensement, 1991–2006 (n=2,7 millions de personnes). Pour cette analyse, on a créé une cohorte limitée à 2,3 millions de personnes âgées de 25 à 64 ans, dont 164 332 sont décédées durant la période de suivi. Les rapports des risques ont été calculés pour toutes les causes confondues et les causes principales de décès, selon le niveau de scolarité (4 niveaux), les compétences professionnelles (6 catégories) et la suffisance du revenu (5 quintiles). On a exécuté des modèles séparément pour les hommes et les femmes, en tenant compte de variables multiples simultanément, et certains ont été stratifiés par cohortes d’âge de 10 ans.


L’ampleur des inégalités socioéconomiques influant sur la mortalité variait selon l’indicateur de la situation socioéconomique (niveau de scolarité, profession ou revenu), le groupe d’âge, le sexe et la cause de décès. Comparativement aux modèles ajustés en fonction de l’âge, les rapports des risques étaient atténués, mais demeuraient importants dans les modèles ajustés en fonction de l’âge et des trois indicateurs de la situation socioéconomique simultanément. Des inégalités socioéconomiques influant sur la mortalité ont été observées pour la plupart des causes principales de décès examinées.


Cette étude démontre que le niveau de scolarité, la profession et le revenu étaient tous associés de manière indépendante à la mortalité et n’étaient pas simplement des variables de substitution l’une pour l’autre. Dans le cadre de l’étude des inégalités socioéconomiques influant sur la mortalité, il est important d’utiliser différents indicateurs de la situation socioéconomique afin de brosser un tableau plus complet.

Mots clés

Canada/épidémiologie facteurs socioéconomiques mortalité 


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Copyright information

© The Canadian Public Health Association 2013

Authors and Affiliations

  • Michael Tjepkema
    • 1
    Email author
  • Russell Wilkins
    • 2
  • Andrea Long
    • 3
  1. 1.Health Analysis DivisionStatistics CanadaOttawaCanada
  2. 2.Department of Epidemiology and Community MedicineUniversity of OttawaOttawaCanada
  3. 3.Public Health Agency of CanadaOttawaCanada

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