Contextual determinants of cardiovascular diseases: overcoming the residential trap by accounting for non-residential context and duration of exposure.
Multilevel neighbourhood analyses rarely account for (1) non-residential exposures and (2) duration of exposure, which have the potential to improve contextual level variance explained, model fit and strength of associations. Using cross-classified logistic regressions, we evaluate the impact of socio-environmental factors at work and home on cardiovascular disease risk for 1626 adults in Toronto-Canada. In the fully-adjusted model, increased CVD risk was associated with poor food environments, lack of parks/recreational facilities, home and work proximity to a major road and noise, and working in a low-SES neighbourhood (p<0.05). Adjusting for exposure duration improved model fit and the strength of associations.
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, 3rd Floor, Toronto, Ontario, Canada M5C 1N8. Electronic address: antony.chum@utoronto.ca.
Antony
A
Chum
Patricia
P
O' Campo
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009864:Ontario; D012111:Residence Characteristics; D018570:Risk Assessment; D012931:Social Environment
Cardiovascular disease; Health geography; Multilevel modeling; Neighbourhood effects; Social determinants of health