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Mitigating effect of immigration on the relation between income inequality and mortality: a prospective study of 2 million Canadians
  1. Nathalie Auger1,2,3,
  2. Denis Hamel1,
  3. Jérôme Martinez1,
  4. Nancy A Ross4
  1. 1Institut National de Santé Publique du Québec, Montréal, Canada, USA
  2. 2Research Centre of the University of Montréal Hospital Centre, Montréal, Canada, USA
  3. 3Department of Social and Preventive Medicine, University of Montréal, Montréal, Canada, USA
  4. 4Department of Geography, McGill University, Montréal, Canada, USA
  1. Correspondence to Dr Nathalie Auger, Institut National de Santé Publique du Québec, 190, Boulevard Crémazie Est, Montréal, Québec H2P 1E2, Canada, USA; nathalie.auger{at}


Background The relation between income inequality and mortality in Canada is unclear, and modifying effects of characteristics such as immigration have not been examined.

Methods Using a cohort of 2 million Canadians followed for mortality from 1991–2001, we calculated HRs and 95% CIs for income inequality of 140 urban areas (Gini coefficient, Atkinson index, coefficient of variation; expressed as continuous variables) and working age (25–64 y) or post-working age (≥65 y) mortality in men and women according to immigration status, accounting for individual and neighbourhood income, and sociodemographic characteristics. Major causes of mortality were examined.

Results Relative to low income inequality, high inequality was associated with greater working age mortality in male (HRGini 1.08, 95% CI 1.04 to 1.13) and female (HRGini 1.12, 95% CI 1.06 to 1.18) non-immigrants for all income inequality indictors. Results were similar for female post-working age mortality. There was no relation between income inequality and mortality in immigrants. Among Canadian-born individuals, associations were greater for alcohol-related mortality (both sexes) and smoking-related causes/transport injuries (women).

Conclusion Income inequality is associated with mortality in Canadian-born individuals but not immigrants.

  • Effect modifiers (epidemiology)
  • immigration
  • income distribution
  • mortality
  • socioeconomic factors
  • social conditions
  • migration health
  • mortality SI
  • social inequalities

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  • Funding The Canadian Census Mortality Follow-up Study was supported by the Canadian Population Health Initiative. All investigators are independent of the funders.

  • Competing interests None.

  • Ethics approval The Canadian Census Mortality Follow-up Study was conducted with the approval of the research ethics committee of the University of Toronto and the Statistics Canada Policy Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.