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Investigating the association between income inequality in youth and deaths of despair in Canada: a population-based cohort study from 2006 to 2019
  1. Claire Benny1,
  2. Brendan T Smith2,3,
  3. Elaine Hyshka1,4,
  4. Ambikaipakan Senthilselvan1,
  5. Paul J Veugelers1,
  6. Roman Pabayo1,5
  1. 1School of Public Health, University of Alberta, Edmonton, Alberta, Canada
  2. 2Public Health Ontario, Toronto, Ontario, Canada
  3. 3University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
  4. 4Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada
  5. 5Centre for Healthy Communities, University of Alberta School of Public Health, Edmonton, Alberta, Canada
  1. Correspondence to Claire Benny, University of Alberta School of Public Health, Edmonton, Alberta T6G 1C9, Canada; cbenny{at}ualberta.ca

Abstract

Background Deaths due to suicide, drug overdose and alcohol-related liver disease, collectively known as ‘deaths of despair’, have been markedly increasing since the early 2000s and are especially prominent in young Canadians. Income inequality has been linked to this rise in deaths of despair; however, this association has not yet been examined in a Canadian context, nor at the individual level or in youth. The study objective was to examine the association between income inequality in youth and deaths of despair among youth over time.

Methods We conducted a population-based longitudinal study of Canadians aged 20 years or younger using data from the Canadian Census Health and Environment Cohorts. Baseline data from the 2006 Canadian Census were linked to the Canadian Vital Statistics Database up to 2019. We employed multilevel survival analysis models to quantify the association between income inequality in youth and time-to deaths of despair.

Results The study sample included 1.5 million Canadians, representing 7.7 million Canadians between the ages of 0 and 19 at baseline. Results from the weighted, adjusted multilevel survival models demonstrated that income inequality was associated with an increased hazard of deaths of despair (adjusted HR (AHR) 1.35; 95% CI 1.04 to 1.75), drug overdose (AHR 2.38; 95% CI 1.63 to 3.48) and all-cause deaths (AHR 1.10; 95% CI 1.04 to 1.18). Income inequality was not significantly associated with suicide deaths (AHR 1.23, 95% CI 0.93 to 1.63).

Conclusion The results show that higher levels of income inequality in youth are associated with an increased hazard of all-cause death, deaths of despair and drug overdose in young Canadians. This study is the first to reveal the association between income inequality and deaths of despair in youth and does so using a population-based longitudinal cohort involving multilevel data. The results of this study can inform policies related to income inequality and deaths of despair in Canada.

  • MENTAL HEALTH
  • ADOLESCENT
  • SUBSTANCE ABUSE
  • SUICIDE

Data availability statement

Data may be obtained from a third party and are not publicly available. Data are not publicly available but may be accessed through the Canadian Research Data Centre Network.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data are not publicly available but may be accessed through the Canadian Research Data Centre Network.

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Footnotes

  • Twitter @clerry13

  • Contributors CB contributed to the study conceptualisation, statistical analysis and original writing/editing of the manuscript. BS contributed to the funding acquisition and revision of the original manuscript. EH contributed to the funding acquisition and revision of the original manuscript. AS contributed to the statistical analysis and revision of the original manuscript. PV contributed to the supervision and the revision of the original manuscript. RP contributed to the study conceptualisation, funding acquisition, supervision and revision of the original manuscript, and is the guarantor of this work.

  • Funding This study was funded by Canadian Institutes of Health Research and the Institute of Population and Public Health (438740). This research has been funded by the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute. RP is a Tier 2 Canada Research Chair.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.