People living in the most deprived areas of Ontario have far greater odds of falling victim to avoidable deaths than those in the most affluent neighbourhoods, and the gap has been widening despite social and medical advancements, according to new research.

Between 1993 and 2014, Ontarians living in areas with low income, low education and high unemployment levels suffered higher the rates of avoidable death compared to those living in well-off neighbourhoods across the province, the study published Wednesday in the Canadian Journal of Public Health concluded.

The study found that the rates of avoidable death in Ontario in that 20-year span declined overall, from 216 down to 111 per 100,000 people. Despite the overall improvement, the gap widened between well-off and deprived neighbourhoods. The avoidable death rates in the least well-off neighbourhoods increased from two times higher than in the most well-off neighbourhoods in 1993 to 2.5 times in 2014.

Avoidable deaths were defined as deaths that occur before someone turns 75 that could have been prevented or medically treated — preventable through good public health policies, such as curbing alcohol and smoking use, preventing suicides or falls; or treatable through early detection and medical care.

“These numbers aren’t trivial,” said lead researcher Dr. Austin Zygmunt, a family physician in Ottawa and public health and preventive medicine resident at the University of Ottawa.

“There were 60,000 more deaths in these poor areas over 20 years, and that’s 3,000 deaths a year, which is a pretty huge number.”

Based on available data from provincial public health institutions, the researchers found that there were about two million deaths in Ontario during that 20-year span, 25 per cent of which were deemed avoidable. That’s half a million of people whose deaths could have been avoided or prevented, said Zygmunt.

To conduct the study, the researchers ranked all neighbourhoods in Ontario every year based on four social dimensions: material deprivation (income, education, unemployment levels), residential instability (home security, ownership, and occupancy), dependency (a measure of workforce eligibility that considers the numbers of children, seniors and single-parent families), and ethnic concentration (amount of new immigrants and visible minorities).

Unlike the first three measures which were linked with greater mortality, the study found that living in an ethnically diverse neighbourhood in Ontario was protective against having a death from an avoidable cause.

The researchers who worked on this study were from ICES (Institute for Clinical Evaluative Sciences), the Ottawa Hospital, and Bruyère Research Institute.

Zygmunt said the number of avoidable deaths has decreased by about a half for the past 20 years, mainly because of medical progress and improvement in universal health care systems.

However, it was “very concerning” to find that there’s still a disparity in how people at both ends of the poverty spectrum benefit from health care improvements, he said.

“People living in the most well-off neighbourhoods benefited the most compared to the least well-off neighbourhoods, even after we considered things like age, gender and chronic diseases,” he said.

“We know that the health care system is working, we just need to do a better job at helping those who are in the less well-off neighbourhoods.”

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Jessica Hales, advocate with the Ontario Coalition Against Poverty (OCAP) and a nurse practitioner in the Dundas-Sherbourne neighbourhood, said she sees the impact of inadequate income and housing instability on health every day.

“Many people who are poor or homeless also face inequitable access to health care services,” she said, adding that living in “inhumane” shelter conditions, being on poor diet, or dealing with chronic sleep deprivation and extreme stress contribute to new and worsening illness and premature deaths.