The Atlas, and What It Shows
The LHIN Mortality Atlas, developed by the Population Health Analytics laboratory as an initiative of the OPTIMISE research program, explores the trends in Ontario’s local health integration networks from 1992-2015. Specifically, the Atlas reveals 4 major findings about adult mortality trends in Ontario over that time:
i) All-cause and premature mortality has declined significantly in Ontario between 1992 and 2015.
ii) Ontario’s health systems and broader policies around health-determinants have been successful—increasingly so—at preventing early deaths over this time.
iii) Geographic, socioeconomic, and sex differences significantly affected the mortality trends of the past 2 decades.
iv) Mortality inequalities between LHINs and socioeconomic groups have widened since 1992.
The Positives
The 34% decline in all-cause mortality in Ontario between 1992 and 2015 (40% in men, 30% in women) can be attributed, in part, to large improvements in several-cause specific mortality rates, including cardiovascular and circulatory mortality, and respiratory mortality.
In addition, Ontario saw a 20% decrease in premature mortality (deaths before age 75), which indicates an increase in lifespan among Ontarians over the last two decades. The gap between male and female mortality has also narrowed.
Finally, the premature mortality of some LHINs in particular (like Toronto Central, Mississauga, and Halton) reduced by as much as 35%, which is part of a grander trend of better overall mortality rates in LHINs near central Ontario (Greater Toronto and Hamilton Area).
Areas for Improvement
The Atlas also revealed trends that require careful attention. The most striking of these is the geographic disparity across all mortality indicators. In simplest terms, mortality risk varies quite substantially based on where in the province a person lives, especially for those living in the North East, North West, and South East Ontario LHINs.
In these LHINs (specifically the North East and North West), no measured improvement occurred in premature mortality among females. This is contrasted by the 19% improvement in premature mortality among Ontario females in general, and the 33% improvement in the Toronto Central LHIN.
These regional disparities were most pronounced in cardiovascular/circulatory, cancer, and external cause (injury and poisoning) mortality, as well as in deaths amenable to public health and/or medical intervention. One concern is that some of these geographic disparities did not diminish, and in some cases grew between 1992 and 2015.
Socioeconomic gradients are also important factors in the current rates of premature mortality such that areas of high material deprivation saw increased premature mortality rates. Unfortunately, this socioeconomic inequality is not decreasing. Between 1992-2015, the relative index of inequality indicator for Ontario grew, meaning not all groups of people are experiencing the same benefits of the province’s overall decline in premature mortality.
Mapping the Future
Like any good map, the LHIN mortality Atlas reveals the lay of the land top-down, revealing the trends and tendencies existing, in this case, in Ontario’s local health geography. With the knowledge provided by the LHIN Mortality Atlas, policymakers and epidemiologists alike can see where to refocus their energy heading forward so that they may both assist the continued decline in Ontario’s overall premature mortality, and encourage that same beneficial decline in our province’s more neglected areas.
Study authors include: Emmalin Buajitti, Tristan Watson, Kathy Kornas, Catherine Bornbaum, David Henry, and Laura Rosella.