Health Analysis Division, Statistics Canada, Ottawa, Ontario.
Centre for Demography, Statistics Canada, Ottawa, Ontario.
Health Rep. 2020 Jan 15;31(1):3-14. doi: 10.25318/82-003-x202000100001-eng.
Life expectancy (LE) and health expectancy have increased throughout much of the world. However, these gains have not been shared equally across all population groups. Socioeconomic disparities exist, though varied methodologies and data sources have made it difficult to ascertain changes over time in Canada.
The 1996 and 2011 Canadian Census Health and Environment Cohorts, with a five-year mortality follow-up, were used to estimate the LE of the household population at ages 25 and 65, according to individual-level education and income. Health status was measured by the Health Utilities Index Mark 3 instrument in two national population health surveys and was used to adjust LE to estimate health-adjusted life expectancy (HALE). Disparities in LE and HALE, and differences between cohorts, were examined.
LE, HALE and the ratio of HALE to LE were greater at higher levels of education or income. A stepwise gradient was also observed by level of education within and across income quintiles, with people in the lowest combined education and income categories at the greatest disadvantage. Disparities were wider in the 2011 cohort compared with the 1996 cohort, but not necessarily to the same extent for both sexes or at different ages.
In Canada, education-related and income-related disparities in life and health expectancy persist and may be wider than they were in the past. This underscores the importance of ongoing data development for routine monitoring of trends in mortality and morbidity, which can, in turn, inform policy development and planning to advance health equity.
在世界上的许多地方，预期寿命（LE）和健康预期寿命都有所增加。然而，这些收益并没有在所有人群中平等分享。尽管存在社会经济差距，但由于方法和数据来源的多样性，加拿大很难确定其随时间的变化。
使用 1996 年和 2011 年加拿大人口普查健康和环境队列，进行五年的死亡率随访，根据个人教育和收入水平，估算 25 岁和 65 岁家庭人口的 LE。使用两项全国性人口健康调查中的健康效用指数 Mark 3 工具来衡量健康状况，并将 LE 进行调整以估计健康调整预期寿命（HALE）。检查了 LE 和 HALE 的差异以及两个队列之间的差异。
LE、HALE 和 HALE 与 LE 的比值在较高的教育或收入水平上更高。还观察到在收入五分位数内和跨越收入五分位数的教育水平之间存在逐步梯度，处于最低综合教育和收入类别的人群处于最大劣势。与 1996 年队列相比，2011 年队列的差异更大，但并非对所有性别或不同年龄都是如此。
在加拿大，与教育相关和与收入相关的预期寿命和健康预期寿命的差距仍然存在，并且可能比过去更大。这强调了持续的数据开发对于监测死亡率和发病率趋势的重要性，这反过来又可以为推进健康公平制定政策和规划提供信息。
