Income inequality and health in Ontario: A multilevel analysis

Abstract

Objectives. To examine the association of income inequality at the public health unit level with individual health in Ontario. Design. Cross sectional multilevel study. Individual-level data drawn from 30,939 respondents in Ontario Health Survey 1996--1997. Median area income and income inequality calculated from 1996 census data, the latter using Gini coefficient. Setting. 37 public health units in Ontario. Subjects. Ontario residents aged 25 years or older. Main outcome measures. Self-rated health status and the Health Utility Index. Results Controlling for individual-level factors, respondents living in public health units in the highest income inequality tercile had odds ratios of 1.25 (95% CI 1.10--1.42) for fair/poor self-rated health, and 1.14 (95% CI 1.04--1.25) for a Health Utility Index score <1, compared with people living in public health units in the lowest tercile. Controlling further for median area income had little effect on the association. Conclusions. Income inequality was significantly associated with individual health status independent of individual income at public health unit level in Ontario.