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Health Policy. 2016 Sep;120(9):1040-50. doi: 10.1016/j.healthpol.2016.07.019. Epub 2016 Aug 3.

Socioeconomic gradient in health in Canada: Is the gap widening or narrowing?

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School of Health Administration, Faculty of Health Professions, Dalhousie University, 5161 George Street, Suite 700, Halifax, NS B3J 1M7, Canada. Electronic address:
Geriatric Medicine Research, Faculty of Medicine, Dalhousie University, Canada.



Notwithstanding a general improvement in health status, the socioeconomic gradient in health remains a public health challenge worldwide.


Using longitudinal data from the National Population Health Survey (NPHS, n=17,276), we examined trends in socioeconomic gradients in two health indicators, viz. the Health Utility Index (HUI) and the Frailty Index (FI), among Canadian adults (25 years and older) between 1998/9-2010/11.


The relative and slope indices of inequality (RII and SII, respectively) were employed to summarize income- and education-based inequality in the FI and the HUI in Canada as whole, and in five regions: the Atlantic provinces, Quebec, Ontario, the Prairies and British Columbia.


We found that education- and income-related inequalities in health were present in all five regions of Canada. The estimated RIIs and SIIs suggested that education-related inequalities in the FI and the HUI increased among women. The results also revealed that relative and absolute income-related inequalities in the HUI increased in Canada, especially among women. Both absolute and relative inequalities indicated that income-related inequalities in the HUI increased in Quebec and in the Prairies over time.


Persistent and growing socioeconomic inequalities in health in Canada over the past one and half decades should warrant more attention. The mechanisms underlying socioeconomic-related inequalities in Canada are less clear. Therefore, further studies are required to identify effective polices to reduce the socioeconomic gradient in health in Canada.


Canada; Education; Frailty Index; Health Utility Index; Income; Socioeconomic inequalities

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