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Income inequality and ‘hospitalisations of despair’ in Canada: a study on longitudinal, population-based data
  1. Claire Benny1,2,
  2. Arjumand Siddiqi3,
  3. Roman Pabayo1
  1. 1School of Public Health, University of Alberta, Edmonton, Alberta, Canada
  2. 2Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
  3. 3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Claire Benny, University of Alberta School of Public Health, Edmonton, AB T6G 1C9, Canada; cbenny{at}ualberta.ca

Abstract

Background Rates of drug overdoses, alcohol-related liver disease and suicide attempts represent a major public health burden in Canada. While the existing literature does highlight some evidence of association between income inequality and mental health and deaths of despair, no existing research has investigated more intermediate events. As such, the objective of the current study is to investigate the association between income inequality and hospitalisations of despair over time.

Methods Data from the 2006 Canadian Census, the 2007/2008 Canadian Community Health Survey and the 2007–2018 Discharge Abstract Database were linked. Data were analysed using Cox proportional hazards modelling accounting for robust standard errors at the area level to investigate associations between income inequality at baseline and hazards for hospitalisations of despair, hospitalisations attributable to drug overdose, alcohol-related liver disease and suicide attempts, and all-cause hospitalisations, while controlling for sociodemographics characteristics (including income) and relevant area-level variables.

Results The results highlighted statistically significant associations between income inequality and hazard of hospitalisations of despair (HR 1.38, 95% CI 1.06 to 1.80), hospitalisations related to drug overdose (HR 1.51, 95% CI 1.07 to 2.13) and all-cause hospitalisations (HR 1.17, 95% CI 1.05 to 1.30). The association between income inequality and hospitalisations related to alcohol-related liver disease and suicide attempts/self-harm were not statistically significant.

Conclusion Overall, the results showed evidence of associations between income inequality and hospitalisations of despair, drug overdose-related hospitalisations and all-cause hospitalisations. These findings are applicable to upstream policy discussion regarding reducing income inequality and identify potential points of intervention for prevention of drug overdose, alcohol-related liver disease and suicide attempts/self-harm.

  • MENTAL HEALTH
  • Health inequalities
  • EPIDEMIOLOGY
  • SUICIDE
  • SUBSTANCE ABUSE

Data availability statement

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

http://dx.doi.org/10.1136/jech-2023-220900

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    Data availability statement

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

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    Footnotes

    • Twitter @clerry13

    • Contributors CB contributed to the writing and revision of the original and revised manuscripts, conducted the analysis and conceptualised the research question. AS contributed to the revision of the original and revised manuscripts and the funding acquisition. RP supervised the writing and analysis of this study, conceptualised the research question, led the funding acquisition and contributed to the writing and revision of the original and revised manuscripts. CB 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. AS and RP are a Tier 2 Canada Research Chairs.

    • Competing interests None declared.

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