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The 2011 and 2016 iterations of the Ontario Marginalization Index: updates, consistency and a cross-sectional study of health outcome associations

van Ingen T, Matheson FI. Can J Public Health. 2021; Aug 25 [Epub ahead of print]. DOI:

Objectives — The Ontario Marginalization Index (ON-Marg) is an area-based measure used widely to measure health inequalities in Ontario. Recently, the index was updated for 2011 and 2016. The loss of the 2011 long-form census required the use of alternative data sources for the 2011 version. This paper describes the update of ON-Marg, assesses consistency in the indices across census years using Dissemination Areas, and examines associations between ON-Marg 2016 and four health and social outcomes to demonstrate its potential to measure health inequalities.

Methods — ON-Marg was created using factor analysis. Differences in quintile assignment was compared over time to assess whether the use of taxfiler, immigration, property assessment, and health card address data in 2011 affected consistency in measurement of marginalization. Inequalities in rates of overall mortality, gonorrhea incidence, mental health emergency department visits, and alcohol retail locations across quintiles of ON-Marg 2016 were quantified using the Relative Index of Inequality.

Results — Depending on the dimension, between 81% and 96% of DAs showed limited or no changes in quintiles of marginalization between 2006, 2011 and 2016. Of the 45-64% of DAs that did not change quintile between 2006 and 2016, 1.8% to 8.8% of DAs in 2011 differed by two or more quintiles. Findings showed significant differences in rates of health and social outcomes across quintiles of ON-Marg 2016, with strength and directionality varying by dimension of ON-Marg.

Conclusion — Alternative data sources did not substantially affect the consistency of the 2011 version of ON-Marg. The updated ON-Marg is a comprehensive tool that can be used to study health inequalities in Ontario.