Social inequalities in COVID-19 deaths in Canada

Highlights Technical report Data tool Technical notes

An archived version of this report is available.

Highlights from 2020 and early 2021

An analysis of death rates between January 2020 and March 2021, to find out if social and economic factors were linked to higher rates of death from COVID-19. Highlights from the technical report: “Social inequalities in COVID-19 mortality by area- and individual-level characteristics in Canada, January 2020 to December 2020/March 2021.”

Overview

The burden of COVID-19 isn't shared equally among Canadians. Some people are more likely to get sick or die because of their social and economic conditions.

This isn't unique to COVID-19. Long before the pandemic, we knew that social and economic disadvantages can affect a person's:

health status
risk of infections and chronic diseases
health behaviours
use of health services

Social inequality contributes to the differences seen in COVID-19 cases, hospitalizations and deaths. However, there hasn't been a lot of national analysis of COVID-19 using this kind of lens.

This report has been updated since the first results were released in July 2021. It helps fill the gap in evidence and data. It explores the inequalities in COVID-19 deaths between January 2020 and March 2021, using several key social determinants of health, such as sex, income and neighbourhood characteristics.

While the original report captured COVID-19 deaths from the first wave of the pandemic (up to August 2020), this updated report includes deaths from subsequent waves of the pandemic in Canada (up to March 2021). The original report has been archived.

You can access visualizations of the data in the COVID-19 mortality data tool.

Method

We looked at national COVID-19 death rates between January 2020 and March 2021, with a focus on factors that are important to health equity. These factors include:

sex
residence in large cities
income
dwelling type
household type
household size

We also looked at national COVID-19 death rates using a variable to identify neighbourhoods that may be disadvantaged by systemic racism and economic inequality. This variable combines 4 other variables. These were measures of the concentration of people in a neighbourhood who:

are a visible minority
recently immigrated to Canada
were born outside of Canada, or
speak neither English nor French

These are the same factors that were looked at in the original report.

Data for this report came from:

2016 short-form Canadian Census
2016 Census Area Profile data
COVID-19 mortality data from Statistics Canada’s provisional and preliminary Canadian Vital Statistics – Deaths database

The data we used had some limitations. For example:

it doesn't include deaths in the Yukon
it probably underestimates the true number of COVID-19 deaths, due to possible reporting delays to the Vital Statistics database.
it provides limited information about gender (refer to the Technical Report for details)
the variables from the 2016 short-form Census (dwelling type, household type, household size, and low-income status) could only be linked to deaths of individuals living in private dwellings, and not in collective dwellings like long-term care homes
information collected on the 2016 Census might have changed between then and the reported death in 2020-21

Despite these limitations, the data we used are useful for understanding general patterns of social inequalities in mortality.

To learn more about how we used these data, please refer to the full technical report.

Key findings

Between January 2020 and March 2021, we found significant inequalities in COVID-19 death rates for people living in large cities, as well as those living in:

apartments
lower-income neighbourhoods
neighbourhoods with more people who:
- are a visible minority
- recently immigrated to Canada
- were born outside of Canada or
- speak neither English nor French

We also found that men had higher rates of COVID-19 deaths than women, especially in these neighbourhoods.

The groups listed above also had the highest rates of COVID-19 deaths at the start of the pandemic. (Please refer to the archived report for more information.) We found 1 main difference when we added later waves of the pandemic to the analysis. The absolute size of these inequalities was larger than what we saw at the start of the pandemic.

These inequalities are consistent with what we know about gender and sexism, systemic racism, economic inequality and other social determinants of health. These conditions affect a person’s:

chances of getting the virus
ability to stay healthy
access to and use of health services

For example, Canada's Health Inequalities Data Tool reveals that men and people living in lower income neighbourhoods report:

less contact with doctors
higher rates of COVID-19 mortality risk factors, such as diabetes and daily smoking

These underlying differences may explain why these socially and economically disadvantaged groups are more likely to die from COVID-19. We need more research to better understand these patterns.

We also need more research to explore the precise ways that inequalities in COVID-19 deaths occur. This report looks at deaths using 1 variable at a time. We didn't look at death rates across multiple variables at once. For example, we didn't look at death rates by household size for low-income and higher-income areas separately. Patterns may be different across groups, and can help us understand how inequalities occur. A more complex analysis that considers many factors together would help us understand how different factors interact.

Conclusion

We’ve provided national evidence of health inequality in COVID-19 deaths during the first year of the pandemic.

Canadians living in socially and economically disadvantaged situations have higher COVID-19 death rates. This is a health equity issue.

Health inequities are avoidable health differences between groups. They are unfair and unjust. They should be addressed through a health equity approach, which promotes healthy living and working conditions for all.

This report is a key step for advancing a fairer pandemic response. It builds on a 2018 report from the Pan-Canadian Health Inequalities Reporting (HIR) Initiative, which outlined actions to promote health equity.

For more information, please refer to Key Health Inequalities in Canada: A National Portrait.

About this report

This report is a product of the HIR Initiative, which is a collaboration between:

Public Health Agency of Canada
Pan-Canadian Public Health Network
Statistics Canada
Canadian Institute for Health Information

Based on a framework developed by the World Health Organization, the HIR Initiative aims to strengthen the measurement, monitoring and reporting of health inequalities in Canada. It does this by:

improving access to data
developing resources to improve our knowledge of health inequalities

You can access data from the HIR Initiative by using the online interactive Health Inequalities Data Tool. It contains over 100 indicators of inequalities in health status, health behaviours and health determinants.

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