Extent and socioeconomic correlates of small area variations in life expectancy in Canada and the United States.

ABSTRACT

Background: An extensive literature documents substantial variations in life expectancy (LE) between countries and at various levels of subnational geography. These variations in LE are significantly correlated with socioeconomic covariates, though no analyses have been produced at the finest feasible census tract (CT) level of geographic disaggregation in Canada or designed to compare Canada with the United States. Data and methods: Abridged life tables for each CT where robust estimates were feasible were estimated comparably with U.S. data. Cross-tabulations and graphical visualizations are used to explore patterns of LE across Canada, for Canada's 15 largest cities, and for the 6 largest U.S. cities. Results: LE varies by as much as two decades across CTs in both countries' largest cities. There are notable differences in the strength of associations with socioeconomic status (SES) factors across Canada's largest cities, though these associations with income-poverty rates are noticeably weaker for Canada's largest cities than for the United States' largest cities. Interpretation: Small area geographic variations in LE signal major health inequalities. The association of CT-level LE with SES factors supports and extends similar findings across many studies. The variability in these associations within Canada and compared with those in the United States reinforces the importance for population health of better understanding differences in social structures and public policies not only at the national and provincial or state levels, but also within municipalities to better inform interventions to ameliorate health inequalities.