Divergent Disability Rates in Canada: Analysis of the Social Determinants of Disability

Reported disability rates in Canada have varied widely between provinces since 1983. Quebec always reports a disability rate about half the Canadian average while Nova Scotia reports a significantly higher rate than the national average. This pattern has been consistent for many years, across surveys and disability identification questions. This research sheds light on possible factors that may influence the robust nature of these discrepancies in the disability rates of these provinces. This research uses the social determinants of health approach to explore risk factors that are potentially associated with the onset of disability. Cross-sectional data are used to examine the details of current disability rates and differences that exist between provinces. Longitudinal data and survival analysis modelling are used to evaluate the factors influencing the onset of disability over time. Determining the influence of these factors over time helps understand how disability rates evolved into the current discrepancies. The findings of this research suggest that Nova Scotia has elevated risks for disability due to a number of factors often related to disability. Nova Scotia has one of the oldest age structures in Canada, low levels of income and education combined with high rates of smoking, obesity and poor health. The combination of these characteristics suggest that the consistently high disability rate in Nova Scotia is logical due to elevated rates for a significant number of risk factors that appear to have a strong influence on the onset of disability. The results of this research regarding the low disability rates in Quebec are less clear. Several factors suggest Quebec’s disability rate should be lower than Nova Scotia, but not at an extremely low level. The age structures of Quebec and Nova Scotia are remarkably similar yet Quebec reports much lower rates of poor health despite a smoking rate and other risk factors for conditions related to disability that are above the national average. However, Quebec also reports significantly lower rates of obesity and a variety of chronic conditions such as arthritis, which combine to produce an environment in Quebec where there are fewer conditions that are often associated with disability.