Development of the Canadian Marginalization Index: a new tool for the study of inequality.

OBJECTIVES: Area-based measures of socio-economic status are increasingly used in population health research. Based on previous research and theory, the Canadian Marginalization Index (CAN-Marg) was created to reflect four dimensions of marginalization: residential instability, material deprivation, dependency and ethnic concentration. The objective of this paper was threefold: to describe CAN-Marg; to illustrate its stability across geographic area and time; and to describe its association with health and behavioural problems. METHODS: CAN-Marg was created at the dissemination area (DA) and census tract level for census years 2001 and 2006, using factor analysis. Descriptions of 18 health and behavioural problems were selected using individual-level data from the Canadian Community Health Survey (CCHS) 3.1 and 2007/08. CAN-Marg quintiles created at the DA level (2006) were assigned to individual CCHS records. Multilevel logistic regression modeling was conducted to examine associations between marginalization and CCHS health and behavioural problems. RESULTS: The index demonstrated marked stability across time and geographic area. Each of the four dimensions showed strong and significant associations with the selected health and behavioural problems, and these associations differed depending on which of the dimensions of marginalization was examined. CONCLUSION: CAN-Marg is a census-based, empirically derived and theoretically informed tool designed to reflect a broader conceptualization of Canadian marginalization.

Gender, income and immigration differences in depression in Canadian urban centres.

BACKGROUND: Immigrants tend to initially settle in urban centres. It is known that immigrants have lower rates of depression than the Canadian-born population, with the lowest rates among those who have arrived recently in Canada. It is established that women and low-income individuals are more likely to have depression. Given that recent immigration is a protective factor and female gender and low income are risk factors, the aim of this study was to explore a recent immigration-low income interaction by gender. METHODS: The study used 2000-01 Canadian Community Health Survey data. The sample consisted of 41,147 adults living in census metropolitan areas. Logistic regression was used to examine the effect of the interaction on depression. RESULTS: The prevalence of depression in urban centres was 9.17% overall, 6.82% for men and 11.44% for women. The depression rate for recent immigrants was 5.24%, 3.87% for men and 6.64% for women. The depression rate among low-income individuals was 14.52%, 10.79% for men and 17.07% for women. The lowest-rate of depression was among low-income recent immigrant males (2.21%), whereas the highest rate was among low-income non-recent immigrant females (11.05%). CONCLUSIONS: This study supports previous findings about the effects of income, immigration and gender on depression. The findings are novel in that they suggest a differential income effect for male and female recent immigrants. These findings have implications for public health planning, immigration and settlement services and policy development.