AGE-SPECIFIC EDUCATION AND INCOME GRADIENTS IN MORBIDITY AND MORTALITY IN A CANADIAN PROVINCE

While important age-related trends in the use of health care services over the past two decades in Canada have been well described, a compre hensive description of socioeconomic gradients in morbidity and mortal ity across age cohorts for a representative population has not been ac complished to date in Canada. The objective of this study was to descr ibe age-specific socioeconomic differentials in mortality and morbidit y for a representative sample of a single Canadian province. The study sample was formed from the linkage of individual respondent records i n the 1986 census to vital statistics records and comprehensive record s of health care utilization for a 5% sample of residents of the provi nce of Manitoba. Using two measures of socioeconomic status derived fr om census responses, attained education and household income, individu als were stratified into age-specific quartile ranks. Based on diagnos tic information contained on health care utilization records, the prop ortion of the sample in treatment during a 12-month observation period was calculated for 15 broadly defined categories of morbidity and tes ted for differences across socioeconomic quartiles. Mortality was inve rsely associated with both income and education quartile rank. Ln the analysis of morbidity, no association between socioeconomic status and treatment prevalence was observed in the majority of the 122 age- and disorder-specific strata tested. Of the observed associations, howeve r, negative relationships were dominant, indicating a higher treatment prevalence among individuals of lower attained education or lower hou sehold income. Across the age course, negative relationships were most frequently present among young and middle aged adults, those aged 30- 64, and were more consistently found for income than for education. Th e general findings of this study of a representative Canadian populati on support observations from other developed country settings that soc ioeconomic differences in relative rates of mortality and morbidity ov er the life course are greatest in the adult years. (C) 1997 Elsevier Science Ltd.