title: Modeling the cumulative effects of social exposures on health: moving beyond disease-specific models.
abstract: The traditional explanatory models used in epidemiology are "disease specific", identifying risk factors for specific health conditions. Yet social exposures lead to a generalized, cumulative health impact which may not be specific to one illness. Disease-specific models may therefore misestimate social factors' effects on health. Using data from the Canadian Community Health Survey and Canada 2001 Census we construct and compare "disease-specific" and "generalized health impact" (GHI) models to gauge the negative health effects of one social exposure: socioeconomic position (SEP). We use logistic and multinomial multilevel modeling with neighbourhood-level material deprivation, individual-level education and household income to compare and contrast the two approaches. In disease-specific models, the social determinants under study were each associated with the health conditions of interest. However, larger effect sizes were apparent when outcomes were modeled as compound health problems (0, 1, 2, or 3+ conditions) using the GHI approach. To more accurately estimate social exposures' impacts on population health, researchers should consider a GHI framework.
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada. heatherlynn.white@mail.utoronto.ca
authors.forename: Heather L
authors.initials: HL
authors.lastname: White
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.forename: Flora I
authors.initials: FI
authors.lastname: Matheson
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking; D002908:Chronic Disease; D003920:Diabetes Mellitus; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009765:Obesity; D016017:Odds Ratio; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D013997:Time Factors; D014028:Tobacco Smoke Pollution; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution