Geographic Disparity in Premature Mortality in Ontario, 1992-1996

Objectives: This article examines the extent of geographic disparity in premature mortality in Ontario and considers factors that may underlie variations in premature mortality across geographic areas. Data Source: Mortality data for years 1992-1996 were obtained from Vital Statistics Records, Office of the Registrar General, Ontario Ministry of Consumer and Commercial Relations. Population data for years 1992-1996 were obtained from Statistics Canada intercensal population estimates (CANSIM database). Data are also presented from the household component of the 1996/97 National Population Health Survey and from the 1996 Statistics Canada Census. Analytical Techniques: All-cause, sex and disease chapter specific premature mortality in Ontario were analyzed at the regional, district health council and public health unit level to determine the extent of geographic disparity. We calculated standardized mortality ratios for persons aged 0-74 years to identify geographic areas with significantly higher or lower premature mortality than expected, using Ontario death rates as the basis for the calculation of expected deaths in the local population. Main Results: Results showed approximately 20% higher than expected all-cause premature mortality for males and females in the North region. However, disparity in all-cause premature mortality in Ontario was most pronounced at the public health unit level, ranging from 20% lower than expected to 30% higher than expected. Premature mortality disparities were largely influenced by neoplasms, circulatory diseases, injuries and poisoning, respiratory diseases and digestive diseases, which accounted for more than 80% of all premature deaths. Premature mortality disparities were also more pronounced for disease chapter specific mortality. Geographic disparities in premature mortality undoubtedly reflect the underlying distribution of population health determinants such as health related behaviours, social, economic and environmental influences.